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Allard-Coutu A, Dobson V, Schmitz E, Shah H, Nessim C. The Evolution of the Sentinel Node Biopsy in Melanoma. Life (Basel) 2023; 13:life13020489. [PMID: 36836846 PMCID: PMC9966203 DOI: 10.3390/life13020489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
The growing repertoire of approved immune-checkpoint inhibitors and targeted therapy has revolutionized the adjuvant treatment of melanoma. While the treatment of primary cutaneous melanoma remains wide local excision (WLE), the management of regional lymph nodes continues to evolve in light of practice-changing clinical trials and dramatically improved adjuvant therapy. With large multicenter studies reporting no benefit in overall survival for completion lymph node dissection (CLND) after a positive sentinel node biopsy (SLNB), controversy remains regarding patient selection and clinical decision-making. This review explores the evolution of the SLNB in cutaneous melanoma in the context of a rapidly changing adjuvant treatment landscape, summarizing the key clinical trials which shaped current practice guidelines.
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Affiliation(s)
- Alexandra Allard-Coutu
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Erika Schmitz
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Hely Shah
- Department of Medical Oncology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Carolyn Nessim
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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Pizarro Á. Lymphadenectomy After a Positive Sentinel Lymph Node Biopsy in Melanoma: A Paradigm Shift. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:298-302. [PMID: 29496198 DOI: 10.1016/j.ad.2018.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/13/2018] [Accepted: 01/21/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Á Pizarro
- Unidad de Prevención y Diagnóstico Precoz de Melanoma, Clínica Dermatológica Internacional, Madrid, España.
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Geimer T, Sattler E, Flaig M, Ruzicka T, Berking C, Schmid-Wendtner M, Kunte C. The impact of sentinel node dissection on disease-free and overall tumour-specific survival in melanoma patients: a single centre group-matched analysis of 1192 patients. J Eur Acad Dermatol Venereol 2016; 31:629-635. [DOI: 10.1111/jdv.13939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- T. Geimer
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - E.C. Sattler
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - M.J. Flaig
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - T. Ruzicka
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - C. Berking
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
| | - M.H. Schmid-Wendtner
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
- Interdisciplinary Oncology Center Munich; Munich Germany
| | - C. Kunte
- Department of Dermatology and Allergy; University Hospital of Munich (LMU); Munich Germany
- Department for Dermatologic Surgery and Dermatology; Artemed Clinic; Munich Germany
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Psaltis J, Reintgen E, Antar A, Giori M, Alvin L, Benjamin A, Budny B, Gianangelo T, Gruman A, Stamas A, Reintgen M, Giuliano R, Smith J, Reintgen D. Malignant melanoma in the pediatric population. World J Surg Proced 2015; 5:229-234. [DOI: 10.5412/wjsp.v5.i3.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/01/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Controversial pigmented lesions in children are a problem for pathologist, clinicians and families that are confronted with this dilemma. Some skin lesions in this population defy diagnosis with pathologists split between a benign diagnosis and a cancer diagnosis. Three cases of controversial pigmented lesions in the pediatric population are presented. Three patients underwent radical resection of the controversial pigmented lesion, intra-operative lymphatic mapping and sentinel lymph node (SLN) biopsy. Due to the low morbidity of the SLN procedure a case is made to perform lymphatic mapping in this clinical scenario. If the SLNs are negative, not much is lost except for the scar and this becomes another line of evidence that perhaps the original lesion was benign. If the SLN shows metastatic cells, then the original skin lesion must be malignant and the patient is offered stage III recommendations that would include complete node dissections and adjuvant Interferon therapy. This strategy provides for adequate treatment of the worse-case scenario, that the skin lesion is malignant. The cost to the patient is a low morbidity procedure, the SLN biopsy.
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Smithers BM, Hughes MCB, Beesley VL, Barbour AP, Malt MK, Weedon D, Zonta MJ, Wood DJ, Triscott JA, Bayley GJ, Brown LJ, Allan CP, D'Arcy J, Williamson R, Khosrotehrani K, Green AC. Prospective study of patterns of surgical management in adults with primary cutaneous melanoma at high risk of spread, in Queensland, Australia. J Surg Oncol 2015; 112:359-65. [PMID: 26310597 DOI: 10.1002/jso.24013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/29/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Knowledge of variation in diagnosis and surgery in high-risk primary melanoma patients is limited. We assessed frequency and determinants of diagnostic procedures, wide local excision (WLE) and sentinel lymph node biopsy (SLNB). METHODS People in Queensland newly diagnosed with melanoma, clinical stage 1b or 2, were recruited prospectively. Patient information was collected from questionnaires and pathology records. Differences in surgical procedures in relation to host and tumor characteristics were assessed. RESULTS In 787 participants, primary melanoma was diagnosed by surgical excision (74%), shave (14%), punch (12%) or incisional (1%) biopsy. General practitioners (GPs) diagnosed 80%. Diagnostic procedure differed by remoteness of residence, health sector, treating doctor's specialty and melanoma site and thickness. 766 patients had WLE, 86% by surgeons. Of 134 residual melanomas, 13 (10%) were ≤ 1 mm at diagnosis but > 1 mm at WLE, mostly after shave biopsy. SLNB was performed in 261 (33%) patients. SLNB was more common in those under 50, in remoter locations or treated by GP initially, and less common with head and neck melanoma. CONCLUSION Diagnostic and surgical procedures for primary melanoma vary substantially and partial biopsy can influence initial tumor microstaging. Patient, tumor and doctor characteristics influence SLNB practice.
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Affiliation(s)
- B Mark Smithers
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Maria Celia B Hughes
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute,, Brisbane, Australia
| | - Vanessa L Beesley
- Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Andrew P Barbour
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Maryrose K Malt
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute,, Brisbane, Australia
| | - David Weedon
- Sullivan Nicolaides Pathology, Indooroopilly, Australia
| | - Mark J Zonta
- The Townsville Hospital, Townsville, Australia
- Mater Medical Centre, Pimlico, Australia
| | | | | | - Gerard J Bayley
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
- Phoenix Plastic Surgery Institute, Greenslopes, Australia
| | - Lee J Brown
- Kawana Private Hospital, Sunshine Coast, Australia
| | - Christopher P Allan
- Queensland Melanoma Project, Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Australia
- Mater Health Services, South Brisbane, Australia
| | | | | | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Centre for Clinical Research & The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Adèle C Green
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute,, Brisbane, Australia
- CRUK Manchester Institute and Institute of Inflammation and Repair, University of Manchester, England
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