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Liu JB, Bilimoria KY. Weighing the value of completion nodal dissection for melanoma. J Surg Oncol 2016; 114:281-7. [PMID: 27444517 DOI: 10.1002/jso.24273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/13/2016] [Indexed: 02/05/2023]
Abstract
In the United States, approximately half of patients with a positive sentinel lymph node biopsy undergo a completion lymphadenectomy. Because of the equivocal survival benefits in pursuing a completion lymphadenectomy in these patients, surgeons must weigh the postoperative morbidity of the operation with concerns facing a patient's quality of life and risk of tumor recurrence. We discuss the value of a completion lymphadenectomy in light of the uncertainties facing this management strategy for melanoma. J. Surg. Oncol. 2016;114:281-287. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jason B Liu
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of Chicago Hospitals, Chicago, Illinois
| | - Karl Y Bilimoria
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.,Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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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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3
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van den Broek FJ, Sloots PC, de Waard JWD, Roumen RM. Sentinel lymph node biopsy for cutaneous melanoma: results of 10 years' experience in two regional training hospitals in the Netherlands. Int J Clin Oncol 2013; 18:428-34. [PMID: 22402887 DOI: 10.1007/s10147-012-0399-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The Multicenter Selective Lymphadenectomy Trial (MSLT-I) demonstrated that the sentinel node (SN) status in cutaneous melanoma affects prognosis and that completion lymphadenectomy in SN-positive patients may improve survival. Our objective was to evaluate sentinel lymph node biopsy (SLNB) in two regional hospitals in the Netherlands. METHODS Patients with localized melanoma were planned for wide excision and SLNB. Completion lymphadenectomy was recommended for positive SN status. Data were compared with the MSLT-I. RESULTS A median of 2 (1-7) SNs were identified in 305 patients and complications occurred in 11%. Fifty-four patients (18%) demonstrated SN metastases and 45 underwent completion lymphadenectomy (20% additional metastases). Six patients with initially negative SN developed lymph node metastases (sensitivity 90%). Overall disease-free survival was 83% (SN-negative 91% vs. SN-positive 41%; p < 0.001) and melanoma-specific survival was 93% (SN-negative 97% vs. SN-positive 62%; p < 0.001). Multivariate regression analysis revealed the SN status to be the most significant predictor for recurrence and melanoma-related death. CONCLUSION Our results of SLNB are comparable to data from high-volume centers participating in MSLT-I. From a patient perspective, the false-negative SN rate of 10% and complication rate of 11% should be weighed against being informed about prognosis and having a possible therapeutic benefit from completion lymphadenectomy.
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Shashanka R, Smitha BR. Head and neck melanoma. ISRN SURGERY 2012; 2012:948302. [PMID: 22570796 PMCID: PMC3337483 DOI: 10.5402/2012/948302] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/24/2012] [Indexed: 12/02/2022]
Abstract
The incidence of malignant melanoma appears to be increasing at an alarming rate throughout the world over the past 30–40 years and continues to increase in the United States, Canada, Australia, Asia, and Europe. The behavior of head and neck melanoma is aggressive, and it has an overall poorer prognosis than that of other skin sites. The authors review the published literature and text books, intending to give an overall picture of malignant melanomas of the head and neck and a special emphasis on treatment considerations with controversies in treatment including biopsy, radiation therapy, sentinel node biopsy, and nodal dissection.
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Affiliation(s)
- R Shashanka
- Department of General Surgery, Hassan Institute of Medical Sciences, Karnataka, Hassan 573201, India
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Darlin L, Persson J, Bossmar T, Lindahl B, Kannisto P, Måsbäck A, Borgfeldt C. The sentinel node concept in early cervical cancer performs well in tumors smaller than 2 cm. Gynecol Oncol 2010; 117:266-9. [PMID: 20167355 DOI: 10.1016/j.ygyno.2010.01.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 01/14/2010] [Accepted: 01/22/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the sentinel node (SLN) concept for lymphatic mapping in early stage cervical cancer. METHODS 105 women with early stage (1a1-2a) cervical cancer were scheduled for the sentinel node procedure in conjunction with a complete pelvic lymphadenectomy. The day before surgery, 1-1.5 mL 120MBq Tc(99) albumin nanocolloid was injected submucosally at four points around the tumor followed by a lymphoscintigram (LSG) to achieve an overview of the radiotracer uptake. RESULTS During surgery, the overall detection rate (gamma probe) of at least one SLN was 90% (94/105 women) whereas at least one SLN was identified in 94% (61/65 women) with a tumor <or=2 cm. Bilateral SLNs were identified in 62/105 (59%) of the women. Among 18 women with any metastatic lymph node 17 had a metastatic SLN (sensitivity 94%, 95% CI 73-100%). Among 61 women with a tumor <or=2 cm, all five women with any metastatic lymph node also had a metastatic SLN (sensitivity 100%). One woman with a 1.5-cm squamous epithelial carcinoma had metastatic positive SLNs on each side but also one metastatic bulky (>2 cm) node without radiotracer uptake. The negative predictive value for patients with cervical cancers <or=2 cm was 100%. CONCLUSIONS The SLN-technique seems to be an accurate method for identifying lymph node metastases in cervical cancer patients with tumors of 2 cm or smaller. In case of a unilateral SLN only, a complete lymphadenectomy should be performed on the radionegative side. All bulky nodes must be removed.
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Affiliation(s)
- Lotten Darlin
- Department of Obstetrics and Gynecology, University Hospital Lund, SE-221 85 Lund, Sweden
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6
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Younan R, Bougrine A, Watters K, Mahboubi A, Bouchereau-Eyegue M, Loutfi A, Tremblay F, Bouffard D, Belisle A, Leblanc G, Nassif E, Martin G, Patocskai E, Alenezi M, Meterissian S. Validation Study of the S Classification for Melanoma Patients with Positive Sentinel Nodes: The Montreal Experience. Ann Surg Oncol 2010; 17:1414-21. [DOI: 10.1245/s10434-009-0876-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Indexed: 11/18/2022]
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Gervasoni JE, Sbayi S, Cady B. Role of lymphadenectomy in surgical treatment of solid tumors: an update on the clinical data. Ann Surg Oncol 2007; 14:2443-62. [PMID: 17597349 DOI: 10.1245/s10434-007-9360-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Accepted: 01/09/2007] [Indexed: 12/31/2022]
Abstract
BACKGROUND The role of lymphadenectomy as an adjunct of standard excision for treatment of cancer is highly debated and controversial. Standard practice for treatment of solid tumors is resection with regional lymphadenectomy. This surgical concept assumes that cancers grow and spread in an orderly manner, from primary cancer to regional lymph nodes and finally to vital organs. We reviewed randomized trials, published a description of lymphatic anatomy and physiology, and presented data that disputed the role of lymphadenectomy as standard practice. The present review updates the literature and reiterates the concept that lymphadenectomy does not increase survival in the surgical treatment of solid tumors. METHODS We reviewed the English-language literature (Medline) for prospective randomized trials and nonrandomized reports, as well as retrospective studies addressing the role of lymphadenectomy in cancers of the esophagus, lung, stomach, pancreas, breast, and skin (melanoma) reported between 2000 and 2006. RESULTS This extensive review demonstrates that there are few prospective randomized trials assessing patient survival with solid tumors that contrast resection with or without lymphadenectomy. However, there was at least one, and for some cancers more than one, prospective randomized trial for each organ site studied, and the data demonstrate no statistically significant difference in overall survival of patients treated with or without lymphadenectomy. Most nonrandomized and retrospective studies, with a few exceptions, support the conclusions of randomized trials; lymphadenectomy does not improve overall survival in solid tumors. Overall survival is primarily a function of the biological nature of the primary tumor, as evidenced by lymphovascular invasion, lymph node involvement, and other prognostic features. CONCLUSIONS This extensive literature review of recent reports indicates that lymphadenectomy does not improve overall survival. Lymph node resection should be conceived in terms of staging, prognosis, and regional control only.
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Affiliation(s)
- James E Gervasoni
- Department of Surgery, Saint Peter's University Hospital, 254 Easton Ave, New Brunswick, New Jersey 08901, USA.
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Thompson JF, Shaw HM. Sentinel Node Mapping for Melanoma: Results of Trials and Current Applications. Surg Oncol Clin N Am 2007; 16:35-54. [PMID: 17336235 DOI: 10.1016/j.soc.2006.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The value of sentinel node (SN) biopsy as a staging procedure and as a guide to prognosis with patients who have melanoma is now clearly established. As well, there is recent clinical trial evidence suggesting a survival benefit for patients found to be SN positive who have an immediate complete lymph node dissection (CLND), compared with those with nodal disease not treated by CLND until it becomes clinically apparent. Clinical trials are ongoing to determine whether CLND is necessary in all patients who are found to be SN positive.
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Affiliation(s)
- John F Thompson
- Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Sydney, Australia.
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Adib T, Barton DPJ. The sentinel lymph node: Relevance in gynaecological cancers. Eur J Surg Oncol 2006; 32:866-74. [PMID: 16765015 DOI: 10.1016/j.ejso.2006.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 03/23/2006] [Indexed: 10/24/2022] Open
Abstract
AIMS Sentinel lymph node (SLN) detection is widely practiced in the management of patients with malignant melanoma and beast cancer. Large studies on SLN detection and determination of nodal status have led to changes in the surgical management of the regional lymph nodes in these diseases. More recently attention has focused on other solid cancers, including gynaecological cancers. METHODS An extensive literature review of published reports on the SLN in gynaecological cancers was undertaken and the reports were categorised according to the level of evidence provided. RESULTS Vulva cancer is the most frequently investigated gynaecological cancer with regard to SLN detection because of its anatomical location and easily accessible nodal basin. Although there are no randomised controlled trials, some data suggest SLN detection in vulval cancer may alter clinical practice and reduce the number of groin lymphadenectomies. The lymphatic drainage of the other gynaecological organs is less predictable, the nodal basin less accessible or less well defined, the techniques not standardised and the evidence for the applicability of SLN detection in the management of these cancers is weak. CONCLUSION Sentinel lymph node detection in vulval cancer may reduce the need for radical groin lymphadenectomy and thereby reduce morbidity. SLN detection for other gynaecological cancers has little potential to alter clinical practice.
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Affiliation(s)
- T Adib
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, 4th Floor Lanesborough Wing, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK
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Khan O, Middleton M. High-risk melanoma with nodal involvement in a young woman. ACTA ACUST UNITED AC 2006; 3:517-21; quiz 522. [PMID: 16955090 DOI: 10.1038/ncponc0582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Accepted: 05/30/2006] [Indexed: 11/08/2022]
Abstract
BACKGROUND An 18-year-old female presented to her General Practitioner with a bleeding mole on her back. The mole had been present since childhood but had started to bleed in the past month. She was otherwise asymptomatic with no relevant previous medical history. Physical examination revealed a 1.5 cm 1.7 cm pigmented lesion on the left aspect of the patient's upper back. There was no palpable lymphadenopathy. INVESTIGATIONS Physical examination, excision biopsy, sentinel lymph node biopsy, CT scan of chest, abdomen and pelvis. DIAGNOSIS Stage IIIB (T3bN2aM0) focally ulcerated, nodular malignant melanoma (Breslow depth 2.5 mm, Clark's level IV). MANAGEMENT Wide re-excision, completion dissection of the left axillary lymph node, adjuvant high-dose interferon with maintenance interferon.
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Affiliation(s)
- Omar Khan
- Cancer Research UK, Department of Medical Oncology, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, UK.
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Gray RJ, Pockaj BA, Vega ML, Connolly SM, DiCaudo DJ, Kile TA, Buchel EW. Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int 2006; 27:696-705. [PMID: 17038281 DOI: 10.1177/107110070602700908] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients diagnosed with melanoma of the foot have been reported to have a poor prognosis. We reviewed our experience at a tertiary-care medical clinic to determine the disease course in patients diagnosed with melanoma of the foot. METHODS A retrospective review was performed of 38 patients with a diagnosis of primary or locally recurrent melanoma of the foot treated between January, 1988, and July, 2004. The main outcome measures included methods of diagnosis, clinical and histopathologic features, and patterns of recurrence. RESULTS The mean age at diagnosis was 61 years; most were women (58%) and Caucasian (95%). The average time to diagnosis was 17 months. Initial clinical diagnosis had been considered benign in 12 (32%). The median Breslow thickness was 1.75 mm, T1 lesions were the most common, and acral lentiginous melanoma accounted for 42%. Thirteen patients (34%) had ulcerated lesions. Sentinel lymph node biopsy specimens of 25 patients identified four (16%) with metastatic disease. Surgical complications occurred in 12 patients, usually after skin graft or soft-tissue flap reconstruction. Systemic recurrence developed in six patients, four of whom also had regional recurrence. CONCLUSIONS Most patients were elderly Caucasian women and most presented with early-stage disease, but diagnosis can be difficult and a subgroup presented with thick melanomas. Reconstructive surgical procedures had a high rate of complications; however, overall functional outcomes were good. Stage of cancer at diagnosis was associated with systemic metastases.
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Affiliation(s)
- Richard J Gray
- Division of General Surgery, Mayo Clinic, Scottsdale, AZ 85259, USA
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Wong SL, Morton DL, Thompson JF, Gershenwald JE, Leong SPL, Reintgen DS, Gutman H, Sabel MS, Carlson GW, McMasters KM, Tyler DS, Goydos JS, Eggermont AMM, Nieweg OE, Cosimi AB, Riker AI, G Coit D. Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol 2006; 13:809-16. [PMID: 16604476 DOI: 10.1245/aso.2006.03.058] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2005] [Accepted: 11/20/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Completion lymph node dissection (CLND) is considered the standard of care in melanoma patients found to have sentinel lymph node (SLN) metastasis. However, the therapeutic utility of CLND is not known. The natural history of patients with positive SLNs who do not undergo CLND is undefined. This multi-institutional study was undertaken to characterize patterns of failure and survival rates in these patients and to compare results with those of positive-SLN patients who underwent CLND. METHODS Surgeons from 16 centers contributed data on 134 positive-SLN patients who did not undergo CLND. SLN biopsy was performed by using each institution's established protocols. Patients were followed up for recurrence and survival. RESULTS In this study population, the median age was 59 years, and 62% were male. The median tumor thickness was 2.6 mm, 77% of tumors had invasion to Clark level IV/V, and 33% of lesions were ulcerated. The primary melanoma was located on the extremities, trunk, and head/neck in 45%, 43%, and 12%, respectively. The median follow-up was 20 months. The median time to recurrence was 11 months. Nodal recurrence was a component of the first site of recurrence in 20 patients (15%). Nodal recurrence-free survival was statistically insignificantly worse than that seen in a contemporary cohort of patients who underwent CLND. Disease-specific survival for positive-SLN patients who did not undergo CLND was 80% at 36 months, which was not significantly different from that of patients who underwent CLND. CONCLUSIONS This study underscores the importance of ongoing prospective randomized trials in determining the therapeutic value of CLND after positive SLN biopsy in melanoma patients.
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Affiliation(s)
- Sandra L Wong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA
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Stitzenberg KB, Thomas NE, Beskow LM, Ollila DW. Population-based analysis of lymphatic mapping and sentinel lymphadenectomy utilization for intermediate thickness melanoma. J Surg Oncol 2006; 93:100-7; discussion 107-8. [PMID: 16425313 DOI: 10.1002/jso.20403] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Lymphatic mapping and sentinel lymphadenectomy (LM/SL) is the nodal staging procedure of choice for patients with intermediate thickness melanoma. We hypothesize that a significant portion of these patients are not undergoing LM/SL. We explore factors that influence use of LM/SL. METHODS Analysis was performed of all incident cases of invasive cutaneous melanoma in North Carolina between January 1, 1999 and December 31, 2001. RESULTS Three thousand four hundred and thirty-six cases of melanoma were reported for 1999-2001. Two hundred and seventy-three cases (8%) were excluded due to metastases. Nine hundred and sixteen cases (29%) were excluded because the T classification was not reported. Of the remaining cases, 1,242 (55%) were intermediate thickness (T2-3); 48% (596/1,242) underwent LM/SL. Subjects >or=60 years old were less likely to receive LM/SL than subjects <60 years (39% vs. 55.4%, P < 0.001). Subjects with head/neck primary tumors were less likely to receive LM/SL than other subjects (33% vs. 51%, P < 0.001). Subjects with T3 tumors were more likely to receive LM/SL than those with T2 tumors (54% vs. 42%, P < 0.001). CONCLUSIONS Half of all patients with intermediate thickness melanoma in North Carolina do not receive LM/SL. Use of LM/SL varies by patient age and primary tumor site. Further investigation is warranted to explore these differences.
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Affiliation(s)
- Karyn B Stitzenberg
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina 2755-7590, USA.
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Doting EH, de Vries M, Plukker JTM, Jager PL, Post WJ, Suurmeijer AJH, Hoekstra HJ. Does sentinel lymph node biopsy in cutaneous head and neck melanoma alter disease outcome? J Surg Oncol 2006; 93:564-70. [PMID: 16705724 DOI: 10.1002/jso.20554] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES In the head and neck region, value, reliability, and safety of sentinel lymph node biopsy (SLNB) have not yet been determined conclusively. The aim of study was to assess impact of SLNB on disease outcome in cutaneous head and neck melanoma. METHODS Thirty-six patients with a clinically node-negative head and neck melanoma, > or =1.0 mm Breslow thickness, participated in a prospective study from 1995 to 2005. Sentinel lymph node (SLN) tumor-positive patients underwent completion lymphadenectomy. SLN tumor-negative patients underwent clinical monitoring. Median follow-up was 54 (range 10-114) months. Recurrence-free and overall survival curves were constructed by Kaplan-Meier. RESULTS SLNs could be identified in 33 patients (92%). In 7 patients (21%) the SLN was tumor-positive. In 1 patient (13%) the SLNB was false-negative. In 17 patients (47%) SLNs could be identified in the parotid region (success rate parotid region 100%). This study showed no significant difference in recurrence-free and overall survival between patients with tumor-positive and tumor-negative SLN. CONCLUSIONS The safety and accuracy of SLNB in the neck and parotid nodal basins were similar to those in non-head and neck sites. However, the technique is technically demanding in this region. In this small series SLNB did not alter disease outcome.
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Affiliation(s)
- Edwina H Doting
- Department of Surgical Oncology, University Medical Center Groningen and Groningen University, Groningen, The Netherlands
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Abstract
BACKGROUND Melanoma of the head and neck and its treatment are complex issues. The behavior of head and neck melanoma is aggressive, and it has an overall poorer prognosis than that of other skin sites. METHODS The authors review current data on the treatment of head and neck melanoma, including both cutaneous and mucosal melanoma. RESULTS Current understanding of the behavior of head and neck melanoma is reviewed and treatment stratagems are presented. Controversies in treatment include lymphoscintigraphy with sentinel node biopsy, nodal dissection, margin size, role of radiation therapy, and reconstruction. The management goal is to treat melanoma aggressively while minimizing the effects of treatment on patient quality of life. CONCLUSIONS Due to its aggressiveness, head and neck melanoma should be treated aggressively when morbidity is not significantly increased. Patient specific treatment is imperative.
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Affiliation(s)
- Matthew A Kienstra
- Head and Neck Oncology Division, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Vuylsteke RJCLM, Borgstein PJ, van Leeuwen PAM, Gietema HA, Molenkamp BG, Statius Muller MG, van Diest PJ, van der Sijp JRM, Meijer S. Sentinel Lymph Node Tumor Load: An Independent Predictor of Additional Lymph Node Involvement and Survival in Melanoma. Ann Surg Oncol 2005; 12:440-8. [PMID: 15864481 DOI: 10.1245/aso.2005.06.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Accepted: 02/05/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Even though 60% to 80% of melanoma patients with a positive sentinel lymph node (SLN) have no positive additional lymph nodes (ALNs), all these patients are subjected to an ALN dissection (ALND) with its associated morbidity. The aim of this study was to predict the absence of ALN metastases in patients with a positive SLN by using features of the primary melanoma and SLN tumor load. METHODS Of 71 SLN-positive patients, 52 had metastasis limited to the SLN (group 1), and 19 had > or =1 positive ALN after ALND (group 2). The tumor load of the SLN was assessed by measuring the total surface area by computerized morphometry. Breslow thickness, ulceration and lymphatic invasion of the primary tumor, and total SLN metastatic area were tested as covariates predicting the absence of positive ALNs. RESULTS The mean SLN metastatic area was 1.18 mm(2) (group 1) and 3.39 mm(2) (group 2) (P = .003) and was the only significant and independent factor after multivariate analysis (P = .02). None of the patients with both a Breslow thickness <2.5 mm and an SLN metastatic area <.3 mm(2) had a positive ALN. CONCLUSIONS SLN metastatic area can be used to predict the absence of positive ALNs in melanoma patients. In this study, patients with a Breslow thickness <2.5 mm and an SLN tumor load <.3 mm(2 )seemed to have no positive ALN and had excellent survival. We hypothesize that this subgroup might not benefit from ALND. Prospective larger trials, using this model and randomizing between ALND and no ALND, should confirm this hypothesis.
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Affiliation(s)
- Ronald J C L M Vuylsteke
- Department of Surgical Oncology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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El-Sayed IH, Singer MI, Civantos F. Sentinel lymph node biopsy in head and neck cancer. Otolaryngol Clin North Am 2005; 38:145-60, ix-x. [PMID: 15649505 DOI: 10.1016/j.otc.2004.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sentinel lymph node biopsy (SLNB) offers a minimally invasive technique to examine the proximal lymph node basin for micrometastases in clinically N0 necks in patients head and neck cancer. This technique has been validated in the management of breast cancer and cutaneous malignant melanoma (CMM) and is under active investigation in the management of multiple other solid tumors.SLNB is used routinely in the management of head and neck melanoma and is investigational for other cancers of the head and neck. SLNB provides prognostic information for patients with CMM and identifies those patients that may benefit from additional treatment. This article examines the history, rationale,science, and current status of SLNB in head and neck with emphasis on melanoma.
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Affiliation(s)
- Ivan H El-Sayed
- Department of Otolaryngology-Head and Neck Surgery, University of California Comprehensive Cancer Center, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
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