Individualized surgery: gamma-probe-guided lymphadenectomy in patients with clinically enlarged lymph node metastases from melanomas

Axillary sentinel node biopsy in prone position for melanomas on the upper back or nape

In patients with melanomas on the upper back or nape, axillary sentinel lymph node (SLN) biopsy (SLNB), when performed in the traditional supine position, is often disturbed by scattered radiation emitted from the primary tumor site. The results from the present study suggestthat axillary SLNB performed in the prone position can solve this problem. We compared two consecutive groups of patients with melanomas of the dorsal trunk or nape who received axillary SLNB performed either in the supine (n = 119) or in the prone position (n = 130). The number of SLNs detected and excised was significantly higher in prone position group (2.4 ± 1.5 SLNs versus 1.9 ± 0.95 SLNs, p = 0.002). Using the prone position, intra-operative repositioning of the patient for excision of a primary site of the upper back or neck was not necessary. The SLN identification rates and the SLN-positivity rates did not differ significantly between the two types of intraoperative patient positioning. There were no significant differences in survival outcomes or false-negative rates. In conclusion, axillary SLNB in prone position yields a higher number of excised SLNs in patients with melanomas of the upper back or nape. Axillary SLNB in prone position is easy to perform and reliable. Intraoperative repositioning of the patient is not necessary, which saves time and resources.

Nodal Basin Recurrence After Sentinel Lymph Node Biopsy for Melanoma: A Retrospective Multicenter Study in 2653 Patients

The objective of this study was to analyze different types of nodal basin recurrence after sentinel lymph node biopsy (SLNB) for melanoma.

PATIENTS AND METHODS

Kaplan-Meier estimates and the Cox proportional hazards model were used to study 2653 patients from 3 German melanoma centers retrospectively.The estimated 5-year negative predictive value of SLNB was 96.4%. The estimated false-negative (FN) rates after 1, 2, 3, 5, and 10 years were 2.5%, 4.6%, 6.4%, 8.7%, and 12.6%, respectively. Independent factors associated with false negativity were older age, fewer SLNs excised, and head or neck location of the primary tumor. Compared with SLN-positive patients, the FNs had a significantly lower survival. In SLN-positive patients undergoing completion lymphadenectomy (CLND), the 5-year nodal basin recurrence rate was 18.3%. The recurrence rates for axilla, groin, and neck were 17.2%, 15.5%, and 44.1%, respectively. Significant factors predicting local relapse after CLND were older age, head, or neck location of the primary tumor, ulceration, deeper penetration of the metastasis into the SLN, tumor-positive CLND, and >2 lymph node metastases. All kinds of nodal relapse were associated with a higher prevalence of in-transit metastases.The FN rate after SLNB steadily increases over the observation period and should, therefore, be estimated by the Kaplan-Meier method. False-negativity is associated with fewer SLNs excised. The beneficial effect of CLND on nodal basin disease control varies considerably across different risk groups. This should be kept in mind about SLN-positive patients when individual decisions on prophylactic CLND are taken.