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Pleunis N, Pouwer AFW, Oonk MHM, van Doorn HC, Tjiong MY, van der Velden J, Zijlmans H, van Poelgeest MIE, van Dorst EB, Slangen BFM, Verhoef LCG, Pijnenborg JMA, de Hullu JA. Incidence of inguinofemoral lymph node metastases at the first local recurrence of vulvar cancer: a Dutch nationwide study. Br J Cancer 2023; 129:956-964. [PMID: 37507545 PMCID: PMC10491599 DOI: 10.1038/s41416-023-02373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/05/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Up to 40% of vulvar cancer patients present with local recurrence within 10 years of follow-up. An inguinofemoral lymphadenectomy (IFL) is indicated if not performed at primary treatment. The incidence and risk factors for lymph node metastases (LNM) at first local recurrence, however, are unclear. Our aim was to determine the incidence of LNM at first local recurrence, in relation to previous groin treatment and clinicopathological factors. METHODS A multicenter cohort study including vulvar cancer patients with a first macroinvasive local recurrence after primary surgical treatment between 2000 and 2015 was conducted in the Netherlands. Groin status at local recurrence was defined as positive (N+), negative (N-) or unknown (N?) and based on histology, imaging and follow-up. Patient-, tumour- and treatment characteristics of primary and recurrent disease were analysed. RESULTS Overall, 16.3% (66/404) had a N+ groin status at first local recurrence, 66.4% (268/404) N- and 17.3% (70/404) N? groin status. The incidence of a N+ groin status was comparable after previous SLN and IFL, 11.5% and 13.8%, respectively. A N+ groin status was related to tumour size (25 vs.12 mm; P < 0.001), depth of invasion (5 vs. 3 mm; P < 0.001) and poorly differentiated tumours (22.9 vs. 11.9%; P = 0.050) at local recurrence. CONCLUSIONS The incidence of LNM at first local recurrence in vulvar cancer patients was 16.3%, and independent of previous type of groin surgery. In accordance with primary diagnosis, tumour size, depth of invasion, and tumour grade were significantly associated with a positive groin status.
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Affiliation(s)
- Noortje Pleunis
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.
- Department of Obstetrics and Gynaecology, Rijnstate Hospital, Arnhem, the Netherlands.
| | - Anne-Floor W Pouwer
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maaike H M Oonk
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Helena C van Doorn
- Department of Gynaecological Oncology, ErasmusMC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Ming Y Tjiong
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Jacobus van der Velden
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Henry Zijlmans
- Department of Gynaecological Oncology, Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | | | - Eleonora B van Dorst
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Lia C G Verhoef
- Department of Radiotherapy, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Johanna M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands
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Wainstein AJA, Cândido LD, Drummond-Lage AP. Sentinel Lymph Node Biopsy after Previous Radical Lymphadenectomy of the Same Lymph Node Basin. J INVEST SURG 2022; 35:1171-1175. [PMID: 35168453 DOI: 10.1080/08941939.2021.1986179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: This study aimed to determine the feasibility of preoperative lymphoscintigraphy and intraoperative radio-guided sentinel lymph node biopsy (SLNB) in patients previously submitted to complete lymphadenectomy (CL) in the same region. There is no current proposal to stage patients diagnosed with a new melanoma after SLNB if the regional lymph node (LN) was removed, preventing this specific population from adjuvant treatments due to understaging.Methods: We assessed six cases of patients with a previous cancer diagnosis (melanoma, breast, or thyroid cancer) who had undergone CL and later developed a new cutaneous melanoma in the same extremity submitted to CL. They underwent preoperative lymphoscintigraphy to locate the sentinel lymph node (SLN), followed by a radio-guided SLNB with the assistance of patent blue dye. A pathologist then evaluated the excised SLN.Results: We had 100% feasibility, all six patients had their SLN located, and three (50%) patients tested positive for metastasis in the excised LNs.Conclusions: All these patients met the criteria to undergo SLNB, but no previous reports demonstrated and corroborated the performance of this procedure in this situation. SLNB with expected drainage for regions previously submitted to a radical lymphadenectomy is a safe and effective procedure. A lymphoscintigraphy allows locating the SLN that is likely to be resected in surgery. In this scenario, we had a 50% positivity, providing how relevant and essential this information is for the prognosis and practical therapeutical approaches for this rare but relevant melanoma population.
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Affiliation(s)
| | - Lucas Dias Cândido
- Post Graduation Department, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Paula Drummond-Lage
- Post Graduation Department, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
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Late Metastatic Melanoma after 25 Years: A Case Report and a Brief Literature Review. Case Rep Surg 2020; 2020:2938236. [PMID: 33178477 PMCID: PMC7647769 DOI: 10.1155/2020/2938236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 10/03/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
The incidence of cutaneous malignant melanoma has shown a drastic increase over recent decades, and approximately 70% of newly diagnosed melanoma are tumors with a Breslow thickness less or equal to 1 mm. In the literature, there are well-documented rare cases of late metastasis of thin melanoma, and given their growing incidence, it is expected in the future to see more cases of late recurrence. We present a case report of a metastatic cutaneous melanoma 25 years from diagnosis and a review of the literature. A 61-year-old female patient presented with a newly discovered asymptomatic nodule on her thigh. Her relevant past medical history included a completely excided lesion with Breslow 1.4 mm thickness in 1989 for which she was followed up according to the guidelines and subsequently declared cured after 10 years of surveillance. Fine-needle aspiration and cytological analysis of the lesion proved to be a subcutaneous localization of malignant melanoma. The lesion was completely excised, and the patient has remained disease free since her surgery. The aim of this case report is to emphasize that late metastasis remains uncommon but a definitive cure from melanoma cannot always be considered a disease-free interval of 10 years. Physicians should always be aware of previous melanoma diagnosis with newly discovered suspicious lesions. Better patient education could improve the detection of recurrence and secondary melanomas without any need for more frequent follow-up visits and a prolonged follow-up time.
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Mattavelli I, Maurichi A, Galeone C, Gallino G, Barbieri C, Leva A, Tolomio E, Valeri B, Cossa M, Patuzzo R, Santinami M. The role of sentinel lymph node status performed in melanoma patients with local recurrence or in transit metastasis. Eur J Surg Oncol 2020; 47:1152-1156. [PMID: 33218700 DOI: 10.1016/j.ejso.2020.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sentinel Node Biopsy (SNB) is routinely performed for primary melanoma, but its role in the treatment of Local Recurrence (LR) and In-Transit metastasis (IT) is controversial. This study aims to assess the role of SNB in melanoma patients who developed first loco-regional recurrence. METHODS A series of consecutive melanoma patients who received SNB for a first IT or LR at the National Cancer Institute of Milan, Italy, from 2000 to 2015 were selected from a prospective database. Clinicopathological characteristics were analyzed. RESULTS Seventy-two patients met selection criteria. Forty-three patients (59.7%) received SNB for LR and 29 (40.3%) for IT. The average interval between treatment of primitive melanoma and first recurrence diagnosis was 19 months (interquartile range: 6.9-49.0). SN identification rate was 97.2%. SN positivity was detected in 26 (37.1%) patients. The SN-positive ratein melanoma patients who had LR or IT was significantly higher than reported for primary tumours. Of patients with nodal involvement 17 had LR and 9 IT lesions. Disease Free Survival (DFS) was slightly higher in SN negative patients, in the absence of statistically significant differences. Overall Survival (OS) analysis showed similar values in the two groups. CONCLUSION Since DFS and OS do not show significant differences between SN negative and positive patients, our data do not give clear indications about performing SNB in case of first LR or IT. However, we suggest submitting patients with LR to this procedure to obtain a more accurate staging and eventually candidate these patients to adjuvant treatment.
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Affiliation(s)
- Ilaria Mattavelli
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Andrea Maurichi
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianfranco Gallino
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Consuelo Barbieri
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Leva
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Tolomio
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Barbara Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mara Cossa
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Roberto Patuzzo
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Mario Santinami
- Melanoma and Sarcoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Quartuccio N, Siracusa M, Pappalardo M, Arnone A, Arnone G. Sentinel Node Identification in Melanoma: Current Clinical Impact, New Emerging SPECT Radiotracers and Technological Advancements. An Update of the Last Decade. Curr Radiopharm 2020; 13:32-41. [PMID: 31749441 PMCID: PMC7509753 DOI: 10.2174/1874471012666191015100837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/20/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Melanoma is the most lethal skin cancer with a mortality rate of 262 cases per 100.000 cases. The sentinel lymph node (SLN) is the first lymph node draining the tumor. SLN biopsy is a widely accepted procedure in the clinical setting since it provides important prognostic information, which helps patient management, and avoids the side effects of complete lymph node dissection. The rationale of identifying and removing the SLN relies on the low probability of subsequent metastatic nodes in case of a negative histological exam performed in the SLN. DISCUSSION Recently, new analytical approaches, based on the evaluation of scintigraphic images are also exploring the possibility to predict the metastatic involvement of the SLN. 99mTc-labeled colloids are still the most commonly used radiotracers but new promising radiotracers, such as 99mTc- Tilmanocept, are now on the market. In the last decades, single photon emission computed tomography- computerized tomography (SPECT/CT) has gained wider diffusion in clinical departments and there is large evidence about its superior diagnostic accuracy over planar lymphoscintigraphy (PL) in the detection of SLN in patients with melanoma. Scientists are also investigating new hybrid techniques combining functional and anatomical images for the depiction of SLN but further evidence about their value is needed. CONCLUSION This review examined the predictive and prognostic factors of lymphoscintigraphy for metastatic involvement of SLN, the currently available and emerging radiotracers and the evidence of the additional value of SPECT/CT over PL for the identification of SLN in patients with melanoma. Finally, the review discussed the most recent technical advances in the field.
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Affiliation(s)
- Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
- Address correspondence to this author at the Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy; Tel: +39091 666 2319; E-mail:
| | - Massimiliano Siracusa
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Marco Pappalardo
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Annachiara Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Gaspare Arnone
- Nuclear Medicine Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
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Zach D, Kannisto P, Stenström Bohlin K, Moberg L, Kjölhede P. Can we extend the indication for sentinel node biopsy in vulvar cancer? A nationwide feasibility study from Sweden. Int J Gynecol Cancer 2019; 30:402-405. [DOI: 10.1136/ijgc-2019-000938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
BackgroundIn squamous cell vulvar cancer, sentinel node biopsy is accepted as standard treatment in well-defined patient groups and has reduced surgical morbidity considerably. Currently, due to the lack of evidence, it cannot be offered to patients with tumors of 4 cm diameter or greater or with multifocal tumors, or in local recurrences.Primary objectiveThis study is primarily a pilot and feasibility trial, aiming to evaluate if the prerequisites concerning detection rate and negative predictive value are satisfactory before the implementation of a multinational trial.Study hypothesisSentinel node biopsy has an acceptable negative predictive value and detection rate in the study cohort.Trial designThis study is planned as a prospective, national, multicenter interventional trial. Participating patients will undergo a sentinel node biopsy in addition to an inguinofemoral lymphadenectomy.Inclusion and exclusion criteriaInclusion criteria: for women in group 1, a primary tumor ≥4 cm in diameter; in group 2, a multifocal primary tumor; in group 3, a local recurrence without previous inguinofemoral lymphadenectomy or radiation to the groins; in group 4, a local recurrence, with previous inguinofemoral lymphadenectomy and/or radiation to the groins.Primary endpointThe primary endpoints are the detection rate and the negative predictive value of the sentinel node procedure.Sample sizeIn each of the four study arms, recruitment of 20–30 patients is planned.Estimated dates for completing recruitment and presenting resultsRecruitment will take place between November 2019 and October 2021. Results will be available in December 2021.Trial registrationThe trial is registered at “ClinicalTrials.gov” (ID: NCT04147780).
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Read RL, Thompson JF. Managing in-transit melanoma metastases in the new era of effective systemic therapies for melanoma. Expert Rev Clin Pharmacol 2019; 12:1107-1119. [DOI: 10.1080/17512433.2019.1689121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Rebecca L Read
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Department of General Surgery, Calvary Health Care, Canberra, Australia
- School of Medicine, Australian National University, Canberra, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
- Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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8
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Nijhuis AAG, Santos Filho IDDAO, Holtkamp LHJ, Uren RF, Thompson JF, Nieweg OE. Sentinel Node Biopsy for Melanoma Patients with a Local Recurrence or In-Transit Metastasis. Ann Surg Oncol 2019; 27:561-568. [DOI: 10.1245/s10434-019-07699-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 12/24/2022]
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9
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Racz JM, Block MS, Baum CL, Jakub JW. Management of local or regional non‐nodal disease. J Surg Oncol 2018; 119:187-199. [DOI: 10.1002/jso.25330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
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Altered lymphatic drainage in malignant melanoma after previous sentinel node biopsy in the same nodal drainage basin. J Plast Reconstr Aesthet Surg 2018; 72:335-354. [PMID: 30467007 DOI: 10.1016/j.bjps.2018.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
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Beasley GM, Hu Y, Youngwirth L, Scheri RP, Salama AK, Rossfeld K, Gardezi S, Agnese DM, Howard JH, Tyler DS, Slingluff CL, Terando AM. Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study. Ann Surg Oncol 2017; 24:2728-2733. [PMID: 28508145 PMCID: PMC9742856 DOI: 10.1245/s10434-017-5883-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is routinely performed for primary cutaneous melanomas; however, limited data exist for SLNB after locally recurrent (LR) or in-transit (IT) melanoma. METHODS Data from three centers performing SLNB for LR/IT melanoma (1997 to the present) were reviewed, with the aim of assessing (1) success rate; (2) SLNB positivity; and (3) prognostic value of SLNB in this population. RESULTS The study cohort included 107 patients. Management of the primary melanoma included prior SLNB for 56 patients (52%), of whom 10 (18%) were positive and 12 had complete lymph node dissections (CLNDs). In the present study, SLNB was performed for IT disease (48/107, 45%) or LR melanoma (59/107, 55%). A sentinel lymph node (SLN) was removed in 96% (103/107) of cases. Nodes were not removed for four patients due to lymphoscintigraphy failures (2) or nodes not found during surgery (2). SLNB was positive in 41 patients (40%, 95% confidence interval (CI) 31.5-50.5), of whom 35 (88%) had CLND, with 13 (37%) having positive nonsentinel nodes. Median time to disease progression after LR/IT metastasis was 1.4 years (95% CI 0.75-2.0) for patients with a positive SLNB, and 5.9 years (95% CI 1.7-10.2) in SLNB-negative patients (p = 0.18). There was a trend towards improved overall survival for patients with a negative SLNB (p = 0.06). CONCLUSION SLNB can be successful in patients with LR/IT melanoma, even if prior SLNB was performed. In this population, the rates of SLNB positivity and nonsentinel node metastases were 40% and 37%, respectively. SLNB may guide management and prognosis after LR/IT disease.
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Affiliation(s)
- Georgia M. Beasley
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Yinin Hu
- Division of Surgical Oncology, University of Virginia, Charlottesville, VA
| | | | | | | | - Kara Rossfeld
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Syed Gardezi
- Division of Surgical Oncology, University of Virginia, Charlottesville, VA
| | - Doreen M. Agnese
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
| | - J. Harrison Howard
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Douglas S. Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Craig L. Slingluff
- Division of Surgical Oncology, University of Virginia, Charlottesville, VA
| | - Alicia M. Terando
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
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Wernick BD, Goel N, Zih FS, Farma JM. A surgical perspective report on melanoma management. Melanoma Manag 2017; 4:105-112. [PMID: 30190913 DOI: 10.2217/mmt-2016-0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/11/2017] [Indexed: 01/27/2023] Open
Abstract
Management of melanoma includes wide excision with adequate margins and lymph node biopsy depending on the depth of the lesion, with subsequent completion lymphadenectomy for positive sentinel node. Locally advanced disease can be approached in several different ways depending on a variety of patient and disease-specific factors. These include surgical resection, isolated limb perfusion and infusion and intralesional injection therapy such as talimogene laherparepvec, IL-2 and Bacille Calmette-Guerin. Ongoing controversy exists regarding the utility of completion lymphadenectomy, and trials such as MSLT-2 will attempt to shed light on this issue. The future of melanoma management will likely focus on expanding the use of immunotherapy, allowing for narrower surgical margins, particularly in sensitive anatomic areas, and limiting the number of completion lymphadenectomies.
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Affiliation(s)
- Brian D Wernick
- St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA.,St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Neha Goel
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA.,Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Francis Sw Zih
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA.,Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Jeffrey M Farma
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA.,Fox Chase Cancer Center, Philadelphia, PA 19111, USA
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Herndon DN. Southern Surgical Association: A Tradition of Mentorship in Translational Research. J Am Coll Surg 2017; 224:381-395. [DOI: 10.1016/j.jamcollsurg.2016.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 12/11/2022]
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Gonzalez AB, Jakub JW, Harmsen WS, Suman VJ, Markovic SN. Status of the Regional Nodal Basin Remains Highly Prognostic in Melanoma Patients with In-Transit Disease. J Am Coll Surg 2016; 223:77-85.e1. [DOI: 10.1016/j.jamcollsurg.2016.03.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/26/2022]
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15
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Repeat sentinel lymph node procedure in patients with recurrent vulvar squamous cell carcinoma is feasible. Gynecol Oncol 2016; 140:415-9. [DOI: 10.1016/j.ygyno.2016.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
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EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma. Eur J Nucl Med Mol Imaging 2015. [PMID: 26205952 DOI: 10.1007/s00259-015-3135-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized melanoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with melanoma. METHODS These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, national nuclear medicine societies, the European Society of Surgical Oncology (ESSO) and the European Association for Research and Treatment of Cancer (EORTC) melanoma group. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). CONCLUSION The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of melanoma patients.
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The Role of Regional Therapies for in-Transit Melanoma in the Era of Improved Systemic Options. Cancers (Basel) 2015; 7:1154-77. [PMID: 26140669 PMCID: PMC4586763 DOI: 10.3390/cancers7030830] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 12/21/2022] Open
Abstract
The incidence of melanoma has been increasing at a rapid rate, with 4%–11% of all melanoma recurrences presenting as in-transit disease. Treatments for in-transit melanoma of the extremity are varied and include surgical excision, lesional injection, regional techniques and systemic therapies. Excision to clear margins is preferred; however, in cases of widespread disease, this may not be practical. Historically, intralesional therapies were generally not curative and were often used for palliation or as adjuncts to other therapies, but recent advances in oncolytic viruses may change this paradigm. Radiation as a regional therapy can be quite locally toxic and is typically relegated to disease control and symptom relief in patients with limited treatment options. Regional therapies such as isolated limb perfusion and isolated limb infusion are older therapies, but offer the ability to treat bulky disease for curative intent with a high response rate. These techniques have their associated toxicities and can be technically challenging. Historically, systemic therapy with chemotherapies and biochemotherapies were relatively ineffective and highly toxic. With the advent of novel immunotherapeutic and targeted small molecule agents for the treatment of metastatic melanoma, the armamentarium against in-transit disease has expanded. Given the multitude of options, many different combinations and sequences of therapies can be offered to patients with in-transit extremity melanoma in the contemporary era. Reported response and survival rates of the varied treatments may offer valuable information regarding treatment decisions for patients with in-transit melanoma and provide rationale for these decisions.
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Hu Y, Shah P, Stukenborg GJ, Slingluff CL. Utility of sentinel lymph node biopsy for solitary dermal melanomas. J Surg Oncol 2015; 111:800-7. [PMID: 25712273 PMCID: PMC4436976 DOI: 10.1002/jso.23890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/02/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Solitary dermal melanoma (SDM) is melanoma confined to subcutaneous and/or dermal layers in the absence of a known primary cutaneous lesion. We hypothesized that sentinel node biopsy is an effective staging strategy for this rare disease. METHODS A Markov decision model was constructed to represent two management strategies for SDM: wide local excision followed by observation, and wide local excision followed by sentinel node biopsy. Utilities, likelihood of positive sentinel node biopsy, and cancer progression rates during a five year time horizon were assigned based on institutional data and a review of existing literature. Estimated costs were derived using Medicare reimbursements. RESULTS Excision followed by sentinel node biopsy provides greater utility, yielding 3.85 discounted quality-adjusted life years (dQALY) compared to 3.66 for excision alone. The incremental cost-effectiveness ratio for sentinel node biopsy is $19,102 per dQALY. Sensitivity analyzes demonstrated that observation is more cost-effective if greater than 23% of sentinel node biopsies are positive (16% reported), or if 5-year survival for observed patients is greater than 76% (69% reported). CONCLUSIONS Based on existing clinical evidence, sentinel node biopsy yields greater utility than excision alone and is cost-effective for patients presenting with solitary dermal melanoma.
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Affiliation(s)
- Yinin Hu
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Puja Shah
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - George J. Stukenborg
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - Craig L. Slingluff
- Department of Surgery/Division of Surgical Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA
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Doepker MP, Zager JS. Sentinel Lymph Node Mapping in Melanoma in the Twenty-first Century. Surg Oncol Clin N Am 2015; 24:249-60. [DOI: 10.1016/j.soc.2014.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abbott A, Shridhar R, Hoffe S, Almhanna K, Doepker M, Saeed N, Meredith K. Robotic assisted Ivor Lewis esophagectomy in the elderly patient. J Gastrointest Oncol 2015; 6:31-8. [PMID: 25642335 DOI: 10.3978/j.issn.2078-6891.2014.095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/29/2014] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Robotic assisted approaches to esophagectomy have demonstrated decreased complications and length of hospitalization. We sought to examine the impact of age on outcomes in patients undergoing robotic assisted Ivor Lewis esophagectomy (RAIL). METHODS A retrospective review of all patients undergoing RAIL from 2009-2013 was conducted. Statistical analysis was performed for the entire cohort and by stratifying patients into three age cohorts: ≤49, 50-69, ≥70. RESULTS We identified 134 patients and found no statistically significant difference for operative time, length of hospitalization, adverse events (AE), or mortality. There was a higher median blood loss (150 cc) seen in cohorts 1 (50-600 cc) and 3 (50-400 cc) compared to cohort 2 [100 (range, 25-400) cc; P<0.01]. The overall AE rate was 10% (cohort 1), 22% (cohort 2), 35% (cohort 3), P=0.13. There were 5 (4%) leaks and 2 (1.5%) deaths, but this was not significantly different between cohorts (P=0.40, P=0.91, respectively). CONCLUSIONS RAIL is a safe surgical technique for use in an aging patient population. There was no increased risk of AE or death in the elderly patients compared to younger patients undergoing the robotic approach.
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Affiliation(s)
- Andrea Abbott
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Ravi Shridhar
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Sarah Hoffe
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Khaldoun Almhanna
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Matt Doepker
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Nadia Saeed
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
| | - Kenneth Meredith
- 1 Moffitt Cancer Center, Tampa, FL, USA ; 2 Department of Surgery, University of Wisconsin, 600 Highlands Avenue, Madison, WI 53792, USA
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Letter to the Editor on “The Importance of Performing a Sentinel Node Biopsy in Case of Recurrent Vulvar Cancer”. Int J Gynecol Cancer 2014; 24:1537. [DOI: 10.1097/igc.0000000000000274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Beasley G, Tyler D. In-transit melanoma metastases: incidence, prognosis, and the role of lymphadenectomy. Ann Surg Oncol 2014; 22:358-60. [PMID: 25266867 DOI: 10.1245/s10434-014-4110-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Indexed: 11/18/2022]
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Read RL, Haydu L, Saw RPM, Quinn MJ, Shannon K, Spillane AJ, Stretch JR, Scolyer RA, Thompson JF. In-transit melanoma metastases: incidence, prognosis, and the role of lymphadenectomy. Ann Surg Oncol 2014; 22:475-81. [PMID: 25256128 DOI: 10.1245/s10434-014-4100-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze a large, single-institution database to further understanding of melanoma in-transit metastases (ITM) with regard to incidence, prognosis, and the role of lymphadenectomy. METHODS A total of 11,614 patients with single primary cutaneous melanomas were treated at Melanoma Institute Australia between January 1994 and December 2009. Of these, 505 developed ITM. Clinicopathologic characteristics, sentinel node (SN) status, patterns of disease progression, and outcomes were analyzed. RESULTS In the 505 patients with ITM, the median primary tumor thickness was 2.95 mm, and 39.4 % were ulcerated. The ITM rates for patients with primary melanomas <1 or ≥1 mm in size and in those who underwent sentinel node biopsy were 0.4, 7.8, and 7.2 %, respectively. The ITM rates for SN-positive and SN-negative patients were 21.6 and 4.7 %, respectively. The median time from primary diagnosis to the development of ITM was 17.9 months. After ITM diagnosis, the median survival time was 19.9 months, 5-year survival was 32.8 %, and 10-year survival was 27.5 %. After ITM diagnosis, primary tumor site (head/neck, trunk) and ulceration were predictors of poorer survival. Five-year survival from the time of ITM ranged from 47.9 % for nonulcerated limb primary lesions to only 13.6 % for ulcerated trunk primary lesions. Elective lymph node dissection in clinically node-negative patients with ITM did not significantly alter overall survival. CONCLUSIONS This large study demonstrates that the diagnosis of melanoma ITM carries serious adverse prognostic implications and will assist in improving the accuracy of staging and prognostic estimates as well as treatment in these patients.
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