1
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Hu T, Xu Y, Yan W, Wang C, Sun W, Kong Y, Chen Y. Prognostic value of the number of biopsied sentinel lymph nodes for Chinese patients with melanoma: A single-center retrospective study. Cancer Rep (Hoboken) 2023; 7:e1958. [PMID: 38148035 PMCID: PMC10849921 DOI: 10.1002/cnr2.1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) helps to determine accurate pathological stages and facilitates strategies for regional disease control in melanoma. However, whether the number of biopsied sentinel lymph nodes (SLNs) influences the patients' survival is rarely investigated. METHODS Acral or cutaneous melanoma patients with no history of nodal disease who received SLNB in Fudan University Shanghai Cancer Center (FUSCC) from January 1, 2017, to December 31, 2021 were retrospectively enrolled. Clinicopathological variables including Breslow index, ulceration, number of positive SLNs, SLN/non-SLN status were analyzed. The pathologic nodal (pN) stage and pathological stage were defined. RESULTS A total of 381 eligible patients were enrolled in this study, of whom 132 (34.7%) patients were diagnosed with SLN-positive. The median number of biopsied SLNs was 2 (range: 1 to 20). Different numbers of biopsied SLNs did not influence the release-free survival (RFS) of the general patients. However, patients with >2 SLNs had a longer RFS than those with 1-2 SLNs in T4, N1a group and those who rejected complete lymph node dissection (CLND). CONCLUSIONS In patients with T4 melanomas, N1a melanomas and those that did not undergo a CLND, the prognosis of those with three or more SLNs retrieved seemed to be improved.
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Affiliation(s)
- Tu Hu
- Department of Musculoskeletal SurgeryFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yu Xu
- Department of Musculoskeletal SurgeryFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Wangjun Yan
- Department of Musculoskeletal SurgeryFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Chunmeng Wang
- Department of Musculoskeletal SurgeryFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Wei Sun
- Department of Musculoskeletal SurgeryFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yunyi Kong
- Department of PathologyFudan University Shanghai Cancer Center, Fudan UniversityShanghaiChina
| | - Yong Chen
- Department of Musculoskeletal SurgeryFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
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2
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Fadel MG, Rauf S, Mohamed HS, Yusuf S, Hayes AJ, Power K, Smith MJ. The Use of Indocyanine Green and Near-Infrared Fluorescence Imaging Versus Blue Dye in Sentinel Lymph Node Biopsy in Cutaneous Melanoma: A Retrospective, Cohort Study. Ann Surg Oncol 2023; 30:4333-4340. [PMID: 37061649 DOI: 10.1245/s10434-023-13405-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The use of indocyanine green (ICG) and near-infrared fluorescence imaging is a promising option for sentinel lymph node (SLN) mapping in cutaneous melanoma. The study objective was to compare the performance of ICG and blue dye at detecting SLNs with radioisotope nanocolloid (technetium-99). METHODS Between April 2018 and June 2022, 293 consecutive patients with cutaneous melanoma (Breslow thickness ≥ 0.8 mm) underwent wide local excision and SLN biopsy. Patients were divided into group A (ICG; n = 122) and group B (blue dye; n = 163). All patients underwent SPECT/CT imaging preoperatively. SLN detection parameters and complications were compared between the groups. RESULTS A total of 285 patients had complete data and were included in the analysis. The median age was 62.0 (range 10-91) years, and 139 (48.8%) were female patients. The mean Breslow thickness was 2.6 mm, 89 (31.2%) patients had ulceration, and 179 (62.8%) patients had mitosis ≥ 1 mm2. The mean number of SLNs detected per patient in group A was 1.58 and group B was 1.48. In groups A and B, the SLN detection rate was 96.7% versus 89.6% (p = 0.022) and the pathological SLN detection rate was 92.3% versus 97.1% (p = 0.481), respectively. CONCLUSIONS ICG had a higher SLN detection rate and equal pathological SLN detection rate to blue dye. ICG may not be inferior to blue dye and is a useful adjunct to radioisotope in SLN biopsy in cutaneous melanoma.
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Affiliation(s)
- Michael G Fadel
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Sidra Rauf
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Hesham S Mohamed
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Siraj Yusuf
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Andrew J Hayes
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Kieran Power
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK
| | - Myles J Smith
- The Sarcoma, Melanoma and Rare Tumours Unit, The Royal Marsden Hospital and Institute Cancer of Research, London, UK.
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3
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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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4
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Li S, Tang J, Wang L, Gou J, You W, Ji Q. Survival analysis in head and neck melanoma after negative sentinel lymph node biopsy: A seer-based population study. EAR, NOSE & THROAT JOURNAL 2022:1455613221126327. [PMID: 36120895 DOI: 10.1177/01455613221126327] [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: 11/15/2022] Open
Abstract
BACKGROUND Cutaneous malignant melanoma (CMM) is one of the most aggressive skin tumors. Sentinel lymph node biopsy (SLNB) is an important test before thorough treatment of melanoma. The aim of this study was to investigate cancer-specific survival (CSS) in patients with head and neck CMM after negative SLNB and to analyze predictors of decreased survival. METHODS Based on the Surveillance, Epidemiology and End Results (SEER) database, a study was conducted using data from patients with head and neck CMM after negative SLNB. The demographic, clinical, and pathological characteristics of the case population were analyzed. Cox univariate, Kaplan-Meier analysis, and multivariate Cox regression models were used to explore predictors of decreased survival; propensity score matching (PSM) analysis was used to reduce confounding bias, and outcomes were compared between the wide margin excision and narrow margin excision groups. RESULTS A total of 1597 confirmed head and neck CMM patients with SLNB-negative were found. A Breslow>4.0 mm was the highest independent risk predictor for patients (HR 3.82, 95% CI 2.04-7.16, P < .001), and significant risk independent predictors also included a high mitotic rate >4 (HR 1.54, 95% CI 1.06-2.25, P = .023). Age< 60 years old was a significant survival predictor (HR 0.56, 95% CI .37-.85, P = .007), and not scalp and neck CMM were also important factors for longer survival (auricle skin: HR .51, 95% CI .29-.90, P = .02; unspecified parts of face: HR .59, 95% CI .40-.87, P = .007). After harmonizing baseline data by PSM, it was found that the extent of surgical resection did not affect patient survival. CONCLUSION This study analyzed the risk factors affecting CSS in patients with CMM of the head and neck region with SLNB-negative and observed a statistically significant difference in the prognosis of patients with CMM in different aesthetic subunits of the head and neck region. Close clinical follow-up for this population is necessary, and periodic medical examinations should be carried out.
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Affiliation(s)
- Shulian Li
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Tang
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lanlan Wang
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Juxiang Gou
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wei You
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Ji
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China
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5
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Turner LM, He M, Piscioneri F, Read R. Improving access and ensuring the quality of melanoma sentinel node biopsy services. ANZ J Surg 2021; 91:2561-2562. [PMID: 34913565 DOI: 10.1111/ans.17338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Lauren M Turner
- Department of Surgery, Division of Critical Care, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Mike He
- Department of Surgery, Division of Critical Care, Canberra Hospital, Garran, Australian Capital Territory, Australia.,Calvary Public Hospital, Canberra, Australian Capital Territory, Australia
| | - Frank Piscioneri
- Department of Surgery, Division of Critical Care, Canberra Hospital, Garran, Australian Capital Territory, Australia.,Calvary Public Hospital, Canberra, Australian Capital Territory, Australia.,ANU Medical School, Canberra, Australian Capital Territory, Australia
| | - Rebecca Read
- Department of Surgery, Division of Critical Care, Canberra Hospital, Garran, Australian Capital Territory, Australia.,Calvary Public Hospital, Canberra, Australian Capital Territory, Australia.,ANU Medical School, Canberra, Australian Capital Territory, Australia
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6
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Cabrera CI, Li S, Conic R, Gastman BR. The National Cancer Database: Survival Between Head and Neck Melanoma and Melanoma of Other Regions. Otolaryngol Head Neck Surg 2021; 167:286-297. [PMID: 34699278 DOI: 10.1177/01945998211053204] [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: 11/16/2022]
Abstract
OBJECTIVE Primary site is considered an important prognostic factor for cutaneous malignant melanoma (CMM); however, opinions vary regarding its influence on survival. This study compares overall survival between head and neck melanoma (HNM) and melanoma of other regions (MOR), as well as between melanoma of the scalp and neck (MSN) and melanoma of other head regions (MOHR). STUDY DESIGN Level III retrospective cohort study. SETTING Patients from Commission on Cancer-accredited cancer programs affiliated to the National Cancer Database (NCDB). METHODS Patients with HNM (MSN and MOHR included) and MOR, stages I to IV (n = 39,754), and their linked survival data using the NCDB were identified. Survival was analyzed using propensity score matching methods. RESULTS After matching using propensity scores, allowing this observational study to mimic a randomized controlled trial, subjects with HNM showed a 22% increased mortality when compared to MOR (P < .01). Among those with HNM, hazard was not proportional over time. Overall, subjects with MSN in the first 3.5 years of follow-up (75% of subjects) showed a 15% increased mortality when compared to MOHR (P < .01); however, after 3.5 years, no difference in survival was noted (P = .5). CONCLUSION Patients with HNM showed a higher mortality when compared to MOR. The risk of death of primary sites within the head and neck varies over time, showing a higher risk of mortality for scalp and neck during the first 3.5 years of follow-up. This increased risk was not evident after the 3.5-year threshold. Further research is needed to evaluate additional patient factors or differences in treatment approaches.
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Affiliation(s)
- Claudia I Cabrera
- Department of Otolaryngology-Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Shawn Li
- Department of Otolaryngology-Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rosalynn Conic
- University of Maryland Medical Center, Department of Surgery, Baltimore, Maryland, USA
| | - Brian R Gastman
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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7
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Weitemeyer MB, Helvind NM, Brinck AM, Hölmich LR, Chakera AH. More sentinel lymph node biopsies for thin melanomas after transition to AJCC 8th edition do not increase positivity rate: A Danish population-based study of 7148 patients. J Surg Oncol 2021; 125:498-508. [PMID: 34672372 DOI: 10.1002/jso.26723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND We evaluated the outcome of sentinel lymph node biopsies (SLNB) in patients with thin melanoma before and after the implementation of AJCC 8th edition (AJCC8) and identified predictors of positive sentinel lymph nodes (+SLN). METHODS Patients diagnosed with T1 melanomas (Breslow thickness ≤1 mm) during 2016-2017 as per AJCC 7th edition (AJCC7) (n = 3414) and 2018-2019 as per AJCC8 (n = 3734) were identified in the Danish Melanoma Database. RESULTS More SLNBs were performed in the AJCC8 cohort compared to the AJCC7 (22.2% vs. 16.2%, p < 0.001), with no significant difference in +SLN rates (4.7% vs. 6.7%, p = 0.118). In the AJCC7 + SLN subgroup, no melanomas were ulcerated, 94.6% had mitotic rate (MR) ≥ 1, 67.6% were ≥0.8 mm and 32.4% would be T1a according to AJCC8. In the AJCC8 + SLN subgroup, 10.3% were ulcerated, 74.4% had MR≥ 1, 97.4% were ≥0.8 mm and 23.1% would be T1a according to AJCC7. On multivariable analysis younger age and MR ≥ 1 were significant predictors of +SLN. CONCLUSION More SLNBs were performed in T1 melanomas after transition to AJCC8 without an increase in +SLN rate. None of the AJCC8 T1b criteria were significant predictors of +SLN. We suggest that mitosis and younger age should be considered as indications for SLNB in thin melanoma.
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Affiliation(s)
- Marie B Weitemeyer
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Neel M Helvind
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Anne M Brinck
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Lisbet R Hölmich
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Annette H Chakera
- Department of Plastic and Reconstructive Surgery, Herlev and Gentofte University Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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8
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Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy Improves the Accuracy of Sentinel Lymph Node Biopsy in Melanoma. Plast Reconstr Surg 2021; 148:83e-93e. [PMID: 34181617 DOI: 10.1097/prs.0000000000008096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite advances in melanoma management, there remains room for improvement in the accuracy of sentinel lymph node biopsy. The authors analyzed a prospective cohort of patients with primary cutaneous melanoma who underwent sentinel lymph node biopsy with lymphoscintigraphy and indocyanine green fluorescence to evaluate the quality and accuracy of this technique. METHODS Consecutive primary cutaneous melanoma patients who underwent sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green fluorescence from 2012 to 2018 were prospectively enrolled. Analysis was performed of melanoma characteristics, means of identifying sentinel lymph nodes, sentinel lymph node status, and recurrence. RESULTS Five hundred ninety-four melanomas and 1827 nodes were analyzed; 1556 nodes (85.2 percent) were identified by radioactivity/fluorescence, 255 (14 percent) by radioactivity only, and 16 (0.9 percent) with indocyanine green only. There were 163 positive sentinel nodes. One hundred forty-seven (90.2 percent) were identified by radioactivity/fluorescence, 13 (8 percent) by radioactivity only, and three (0.6 percent) with fluorescence only. Of the 128 patients with a positive biopsy, eight patients' (6.3 percent) nodes were identified by radioactivity only and four (3.4 percent) with fluorescence only. There were 128 patients with a positive biopsy, 454 with a negative biopsy, and 12 patients who had a negative biopsy with subsequent nodal recurrence. Mean follow-up was 2.8 years. CONCLUSIONS In the study of the largest cohort of patients with primary cutaneous melanoma who underwent a sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green-based technology, the quality and accuracy of this technique are demonstrated. This has important implications for melanoma patients, as the adoption of this approach with subsequent accurate staging, adjuvant workup, and treatment may improve survival outcomes. . CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.
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9
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Wen D, Martin RCW. Proposed quality performance indicators of sentinel lymph node biopsy for cutaneous melanoma. ANZ J Surg 2021; 91:2644-2649. [PMID: 33956390 DOI: 10.1111/ans.16914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/19/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanoma is a leading cause of morbidity and mortality in Australia and New Zealand. New Zealand has the highest melanoma incidence in the world alongside Australia at 54 per 100 000 persons. The aim of this study is to conduct a retrospective quality audit of sentinel lymph nodal biopsy (SLNB) practices from 2007 to 2019 of a high-volume melanoma surgeon. Primary outcome was false negative rate (FNR). Secondary outcomes were sentinel node (SN) identification and removal rate, and complication rates. METHODS A database was maintained, containing n = 553 consecutive SLNB's for cutaneous melanoma from 31 August 2007 to 31 August 2019. Patient characteristics and details of the primary lesion, sentinel lymph node biopsy, recurrence and complications were recorded. RESULTS SN's were successfully identified in 444 (99.6%) out of 446 patients with an FNR of 9.1%. Positive SN's were identified in 70 (12.7%) SLNB's. Complications occurred in 76 out of 553 (13.7%) SLNB's. A review of internationally published literature reveals an SN identification rate of 94.4-99.5% with an FNR of 4.0-37.5%. SLNB is the best staging tool for melanoma and gives potential access to adjuvant systemic treatment if >1 mm deposits are found. It is a day-stay procedure with a low-complication rate. CONCLUSION SLNB is a safe and reliable procedure utilized for cutaneous melanoma. We propose our data should be used alongside international SN series to establish Quality Performance Indicators to improve melanoma management.
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Affiliation(s)
- Daniel Wen
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Richard C W Martin
- Department of Cutaneous Oncology, North Shore Hospital, Waitematā District Health Board, Auckland, New Zealand.,Melanoma Unit, Auckland, New Zealand
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10
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Straker RJ, Carr MJ, Sinnamon AJ, Shannon AB, Sun J, Landa K, Baecher KM, Wood C, Lynch K, Bartels HG, Panchaud R, Lowe MC, Slingluff CL, Jameson MJ, Tsai K, Faries MB, Beasley GM, Sondak V, Karakousis GC, Zager JS, Miura JT. Predictors of False Negative Sentinel Lymph Node Biopsy in Clinically Localized Merkel Cell Carcinoma. Ann Surg Oncol 2021; 28:6995-7003. [PMID: 33890195 DOI: 10.1245/s10434-021-10031-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/02/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is routinely recommended for clinically localized Merkel cell carcinoma (MCC); however, predictors of false negative (FN) SLNB are undefined. METHODS Patients from six centers undergoing wide excision and SLNB for stage I/II MCC (2005-2020) were identified and were classified as having either a true positive (TP), true negative (TN) or FN SLNB. Predictors of FN SLNB were identified and survival outcomes were estimated. RESULTS Of 525 patients, 28 (5.4%), 329 (62.7%), and 168 (32%) were classified as FN, TN, and TP, respectively, giving an FN rate of 14.3% and negative predictive value of 92.2% for SLNB. Median follow-up for SLNB-negative patients was 27 months, and median time to nodal recurrence for FN patients was 7 months. Male sex (hazard ratio [HR] 3.15, p = 0.034) and lymphovascular invasion (LVI) (HR 2.22, p = 0.048) significantly correlated with FN, and increasing age trended toward significance (HR 1.04, p = 0.067). The 3-year regional nodal recurrence-free survival for males >75 years with LVI was 78.5% versus 97.4% for females ≤75 years without LVI (p = 0.009). Five-year disease-specific survival (90.9% TN vs. 51.3% FN, p < 0.001) and overall survival (69.9% TN vs. 48.1% FN, p = 0.035) were significantly worse for FN patients. CONCLUSION Failure to detect regional nodal microscopic disease by SLNB is associated with worse survival in clinically localized MCC. Males, patients >75 years, and those with LVI may be at increased risk for FN SLNB. Consideration of increased nodal surveillance following negative SLNB in these high-risk patients may aid in early identification of regional nodal recurrences.
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Affiliation(s)
- Richard J Straker
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael J Carr
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrew J Sinnamon
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Adrienne B Shannon
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - James Sun
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Karenia Landa
- Department of Surgery, Duke University, Durham, NC, USA
| | | | - Christian Wood
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Kevin Lynch
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Harrison G Bartels
- Division of Head and Neck Surgical Oncology, Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Robyn Panchaud
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael C Lowe
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - Craig L Slingluff
- Division of Surgical Oncology, Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Mark J Jameson
- Division of Head and Neck Surgical Oncology, Department of Otolaryngology - Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Kenneth Tsai
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Mark B Faries
- Cedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA
| | | | - Vernon Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Oncological Sciences at the University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
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11
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Paolino G. Detection of False Negative Sentinel Lymph Node in Cutaneous Oncology: A General Reappraisal. J INVEST SURG 2020; 33:748-749. [PMID: 32772780 DOI: 10.1080/08941939.2018.1563663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Internal Medicine and Medical Specialties, Dermatology Clinic, La Sapienza-University of Rome, Rome, Italy
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12
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Skanjeti A, Dhomps A, Paschetta C, Tordo J, Delgado Bolton RC, Giammarile F. Lymphoscintigraphy for Sentinel Node Mapping in Head and Neck Cancer. Semin Nucl Med 2020; 51:39-49. [PMID: 33246538 DOI: 10.1053/j.semnuclmed.2020.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this comprehensive review is to describe and analyze the role of the sentinel node mapping in head and neck cancers. For this purpose, head and neck neoplasms have been categorized in cutaneous malignancies and neoplasms of the upper aerodigestive tract. A concise description of lymphatic drainage will be the "prelude" for each section, as well as the description of the injection techniques, when specific. Concisely, the attention has been focused on detection rate of the sentinel node by lymphoscintigraphy for each cancer, and for those patients in which the sentinel lymph node has been identified, true-positives rates, false-negative rates, and overall accuracy has been pointed out. Overall, in cutaneous neoplasms of the head and neck, the detection rate is higher than 90%, however the false-negative rate is still an issue, in particular in melanoma, inducing the need for newer developments. In fact, new tracers and techniques are already available, while prospective multicenter trials exploring the outcome impact are needed in the near future. For the upper aerodigestive tract and in particular oral cavity and oropharynx, sentinel lymph node identification by lymphoscintigraphy allows avoiding unnecessary neck dissection and/or node irradiation. Even in this case, the main limit remains the risk of false-negative rates. While, for patients affected by laryngeal and hypopharyngeal cancers the data seem very limited and, although the feasibility has been demonstrated, performances of this lymphoscintigraphy still need to be confirmed by multicenter studies.
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Affiliation(s)
- Andrea Skanjeti
- Nuclear Medicine Department, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France
| | - Anthony Dhomps
- Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France
| | | | - Jérémie Tordo
- Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria; Centre Léon Bérard, Lyon, France.
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13
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Allard-Coutu A, Heller B, Francescutti V. Surgical Management of Lymph Nodes in Melanoma. Surg Clin North Am 2019; 100:71-90. [PMID: 31753117 DOI: 10.1016/j.suc.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article provides a comprehensive evaluation of surgical management of the lymph node basin in melanoma, with historical, anatomic, and evidence-based recommendations for practice.
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Affiliation(s)
- Alexandra Allard-Coutu
- Department of Surgery, McMaster University, Hamilton General Hospital, 237 Barton Street East, 6 North, Hamilton, Ontario L8L 2X2, Canada
| | - Barbara Heller
- Department of Surgery, McMaster University, Hamilton General Hospital, 237 Barton Street East, 6 North, Hamilton, Ontario L8L 2X2, Canada
| | - Valerie Francescutti
- Department of Surgery, McMaster University, Hamilton General Hospital, 237 Barton Street East, 6 North, Hamilton, Ontario L8L 2X2, Canada.
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14
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Knackstedt R, Couto RA, Ko J, Cakmakoglu C, Wu D, Gastman B. Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate. Ann Surg Oncol 2019; 26:3550-3560. [PMID: 31313036 DOI: 10.1245/s10434-019-07617-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature. METHODS Consecutive cutaneous melanoma patients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate. RESULTS Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage. CONCLUSIONS With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.
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Affiliation(s)
- Rebecca Knackstedt
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rafael A Couto
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cagri Cakmakoglu
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daisy Wu
- University of Toledo Medical School, Toledo, OH, USA
| | - Brian Gastman
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
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15
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Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T. New Trends in Cutaneous Melanoma Surgery. Open Access Maced J Med Sci 2019; 7:3090-3092. [PMID: 31850129 PMCID: PMC6910799 DOI: 10.3889/oamjms.2019.828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022] Open
Abstract
The main surgical treatment for melanoma consists in wide surgical excision of the primary lesion and the sentinel node but in recent times management of melanoma is rapidly evolving with the introduction of new systemic therapies, like BRAF inhibitors, MEK inhibitors and antibodies anti-PD-1 that show good results in controlling even advanced stages of the disease. This review aims to present data for the optimal surgical management of patients with malignant melanoma.
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Affiliation(s)
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy, Belgrade, Serbia
| | - Petar Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | | | | | | | | | - Jovana Vojvodic
- Clinic for Psychiatric Disorders "Dr. Laza Lazarevic", Belgrade, Serbia
| | - Goran Sijan
- Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Nenad Stepic
- Chief of Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Dresden, Germany
| | | | - Nguyen Van Thuong
- Vietnam National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Massimo Fioranelli
- Department of Nuclear Physics, Sub-nuclear and Radiation, G. Marconi University, Rome, Italy
| | - Torello Lotti
- Department of Dermatology, University of G. Marconi, Rome, Italy
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16
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Falk Delgado A, Zommorodi S, Falk Delgado A. Sentinel Lymph Node Biopsy and Complete Lymph Node Dissection for Melanoma. Curr Oncol Rep 2019; 21:54. [PMID: 31028497 PMCID: PMC6486528 DOI: 10.1007/s11912-019-0798-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The main surgical treatment for invasive malignant melanoma consists of wide surgical and examination of the sentinel node and in selected cases complete lymph node dissection. The aim of this review is to present data for the optimal surgical management of patients with malignant melanoma. RECENT FINDINGS A surgical excision margin of 1-2 cm is recommended for invasive melanoma depending on the thickness of the melanoma. Sentinel node biopsy may be considered for patients with at least T1b melanomas thickness 0.8 to 1.0 mm or less than 0.8 mm Breslow thickness with ulceration, classified as T1b lesion, per recent AJCC guidelines. Two randomized controlled trials have been published-DeCOG (German Dermatologic Cooperative Oncology Group Selective Lymphadenectomy) and MSLT-2 (Multicenter Selective Lymphadenectomy Trial) comparing the complete lymph node dissection (CLND) with observation after positive sentinel node biopsy. In the MSLT-2 study, the disease control rate was improved in the immediate CLND group compared with observation but there was no difference in 3-year melanoma specific survival (86% ± 1.3% and 86% ± 1.2%, respectively; p = 0.42). Isolated limb perfusion (ILP) or isolated limb infusion (ILI) with melphalan and actinomycin D is recommended for large and multiple in-transit metastases and satellite metastases in the extremities when local excision is considered ineffective or too extensive. In light of new adjuvant treatment options and new indications for checkpoint inhibitors, and the lack of survival benefit after CLND, we can expect open surgery to decrease in melanoma disease.
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Affiliation(s)
- Alberto Falk Delgado
- Department of Plastic Surgery, Uppsala University, Ing 85, Akademiska Sjukhuset, 75185, Uppsala, Sweden.
| | - Sayid Zommorodi
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Falk Delgado
- Clinical neurosciences, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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17
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Thomas DC, Han G, Leong SP, Kashani-Sabet M, Vetto J, Pockaj B, White RL, Faries MB, Schneebaum S, Mozzillo N, Charney KJ, Sondak VK, Messina JL, Zager JS, Han D. Recurrence of Melanoma After a Negative Sentinel Node Biopsy: Predictors and Impact of Recurrence Site on Survival. Ann Surg Oncol 2019; 26:2254-2262. [DOI: 10.1245/s10434-019-07369-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Indexed: 01/03/2023]
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18
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Sirvan SS, Demir IA, Irmak F, Kafi M, Budak K, Karsidag S. Does Wide Excisional Biopsy in Skin Cancer Prevent Finding The Real Sentinel Lymph Node? J INVEST SURG 2019; 33:741-747. [DOI: 10.1080/08941939.2018.1559898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Selami S Sirvan
- Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Isil Akgun Demir
- Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Fatih Irmak
- Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mesut Kafi
- Nuclear Medicine Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kenan Budak
- Nuclear Medicine Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Semra Karsidag
- Plastic, Reconstructive and Aesthetic Surgery Department, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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19
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Gastman BR, Zager JS, Messina JL, Cook RW, Covington KR, Middlebrook B, Gerami P, Wayne JD, Leachman S, Vetto JT. Performance of a 31-gene expression profile test in cutaneous melanomas of the head and neck. Head Neck 2019; 41:871-879. [PMID: 30694001 PMCID: PMC6667900 DOI: 10.1002/hed.25473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/23/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background We report the performance of a gene expression profile test to classify the recurrence risk of cutaneous melanoma tumors of the head and neck as low‐risk Class 1 or high‐risk Class 2. Methods Of note, 157 primary head and neck cutaneous melanoma tumors were identified. Survival analyses were performed using Kaplan‐Meier and Cox methods. Results Gene expression profile class and node status stratified tumors into significantly different 5‐year survival groups by Kaplan‐Meier method (P < .0001 for all end points), and both were independent predictors of recurrence in multivariate analysis. Overall, 74% of distant metastases and 88% of melanoma‐specific deaths had Class 2 risk. Conclusion The gene expression profile test identifies cases at increased risk for metastasis and death independent of a clinically or pathologically negative nodal status, suggesting that incorporation of this molecular tool could improve clinical management of patients with head and neck cutaneous melanoma, especially in those with a negative sentinel lymph node biopsy.
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Affiliation(s)
- Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio
| | - Jonathan S Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Jane L Messina
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Robert W Cook
- Research & Development, Castle Biosciences, Inc., Friendswood, Texas
| | - Kyle R Covington
- Research & Development, Castle Biosciences, Inc., Friendswood, Texas
| | | | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Skin Cancer Institute, Northwestern University, Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Jeffrey D Wayne
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Surgical Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sancy Leachman
- Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - John T Vetto
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
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20
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Summarize the changes to the American Joint Committee on Cancer Eighth Edition Melanoma Staging System. 2. List advances in genetic, molecular, and histopathologic melanoma diagnosis and prognostication. 3. Recommend sentinel lymph node biopsy and appropriate surgical margins based on individualized patient needs. 4. Recognize the currently available treatments for in-transit metastasis and advanced melanoma. 5. Describe current and future therapies for melanoma with distant visceral or brain metastases. SUMMARY Strides in melanoma surveillance, detection, and treatment continue to be made. The American Joint Committee on Cancer Eighth Edition Cancer Staging System has improved risk stratification of patients, introduced new staging categories, and resulted in stage migration of patients with improved outcomes. This review summarizes melanoma advances of the recent years with an emphasis on the surgical advances, including techniques and utility of sentinel node biopsy, controversies in melanoma margin selection, and the survival impact of time-to-treatment metrics. Once a disease manageable only with surgery, a therapeutic paradigm shift has given a more promising outlook to melanoma patients at any stage. Indeed, a myriad of novel, survival-improving immunotherapies have been introduced for metastatic melanoma and more recently in the high-risk adjuvant setting.
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21
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Bartlett EK. Current management of regional lymph nodes in patients with melanoma. J Surg Oncol 2019; 119:200-207. [PMID: 30481384 PMCID: PMC7485600 DOI: 10.1002/jso.25316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/11/2018] [Indexed: 01/19/2023]
Abstract
The publication of recent randomized trials has prompted a significant shift in both our understanding and the management of patients with melanoma. Here, the current management of the regional lymph nodes in patients with melanoma is discussed. This review focuses on selection for sentinel lymph node biopsy, management of the positive sentinel node, management of the clinically positive node, and the controversy over the therapeutic value of early nodal intervention.
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Affiliation(s)
- Edmund K. Bartlett
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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22
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Pameijer CR, Leung A, Neves RI, Zhu J. Indocyanine green and fluorescence lymphangiography for sentinel node identification in patients with melanoma. Am J Surg 2018; 216:558-561. [DOI: 10.1016/j.amjsurg.2018.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/29/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
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23
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Leong SP, Wu M, Lu Y, Torre DM, von Bakonyi A, Ospina AM, Newsom JD, Luckett WS, Soon CW, Kim KB, Kashani-Sabet M. Intraoperative Imaging with a Portable Gamma Camera May Reduce the False-Negative Rate for Melanoma Sentinel Lymph Node Surgery. Ann Surg Oncol 2018; 25:3326-3333. [PMID: 30105436 PMCID: PMC6437127 DOI: 10.1245/s10434-018-6685-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Indexed: 01/09/2023]
Abstract
Background Preoperative imaging and intraoperative gamma probe (GP) localization is standard for identifying sentinel lymph nodes (SLNs) in melanoma patients. The aim of this prospective Institutional Review Board-approved study was to investigate whether an intraoperative portable gamma camera (PGC) improves SLN detection over the GP. Methods Lymphoscintigraphy and single photon emission computed tomography/computed tomography were performed after injection of 99mTc-Tilmanocept in melanoma patients (≥ 18 years, Breslow thickness ≥ 1.0 mm). A GP was used to localize the SLNs in each basin, which was explored by the GP to ensure that the operative field was < 10% counts of the hottest SLN. The PGC was then used after a negative GP screening. Any residual hotspots identified by the PGC were considered as additional SLNs and were removed following the 10% rule. Results Preoperative imaging of 100 patients identified 138 SLN basins, with 306 SLNs being identified by conventional surgery. The PGC localized 89 additional SLNs in 54 patients. Thus, the PGC identified an additional 23% of SLNs [95% confidence interval (CI) 18–27%]. Four of these 89 SLNs showed micrometastasis in four patients, in two of whom the only tumor-positive SLN was identified by the PGC, preventing two false-negative cases. Thus, the null hypothesis that the PGC did not detect additional positive SLNs was rejected (p = 0.000). The overall SLN positive rate was 9.9% (39/395, 95% CI 6–12), and the overall patient positive rate was increased using the PGC, from 25 to 27% (27/100). Conclusions Intraoperative PGC imaging yielded additional SLNs in a significant number of patients over GP alone. Identification of these additional SLNs resulted in upstaging of four patients with two patients being converted from a negative to a positive status, thus, preventing two false-negative cases.
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Affiliation(s)
| | - Max Wu
- California Pacific Medical Center, San Francisco, CA, USA
| | - Ying Lu
- Stanford University, Stanford, CA, USA
| | - Donald M Torre
- California Pacific Medical Center, San Francisco, CA, USA
| | | | | | - James D Newsom
- California Pacific Medical Center, San Francisco, CA, USA
| | | | | | - Kevin B Kim
- California Pacific Medical Center, San Francisco, CA, USA
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24
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Indocyanine green fluorescence imaging with lymphoscintigraphy for sentinel node biopsy in head and neck melanoma. J Surg Res 2018; 228:77-83. [DOI: 10.1016/j.jss.2018.02.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/11/2017] [Accepted: 02/27/2018] [Indexed: 02/05/2023]
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25
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Jaukovic L, Rajović M, Kandolf Sekulovic L, Radulovic M, Stepic N, Mijuskovic Z, Petrov N, Ajdinovic B. Time to Procedure, Nuclear Imaging and Clinicopathological Characteristics as Predictive Factors for Sentinel Lymph Node Metastasis in Cutaneous Melanoma: A Single-Center Analysis. Ann Plast Surg 2018; 81:80-86. [PMID: 29762449 DOI: 10.1097/sap.0000000000001465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Sentinel lymph node (SLN) biopsy is a widely accepted staging procedure for cutaneous melanoma patients who are at risk of clinically occult nodal metastases. Numerous predictive factors for regional lymph node metastases have been identified; however, few have been found to be reproducibly significant. Also, the role of blue dye in identification was questioned in recent trials. Time to procedure was also found to be predictive of SLN positivity, but this was not confirmed in other studies. In our study, predictive factors for metastatic involvement of SLN were analyzed, together with the role of addition blue dye in imaging on detection rate and false-negative SLN rate. An impact of time interval to procedure on the rate of SLN positivity was also explored. METHODS Data analysis was done in 362 cutaneous melanoma patients who underwent lymphoscintigraphy and SLN biopsy at our institution from 2010 to 2016, with a median follow-up of 29 months (1-98 months). To delineate the relation of each variable (demographical, time to procedure, and clinical and pathological variables, as well as the presence of in-transit nodes, the number of draining basins, and SLN localization on scintigraphy) with positive SLN status, we used univariate logistic regression with odds ratios representing effect size. RESULTS Metastatic involvement SLN was found in 67 (18.8%) of 356 patients. Detection rate was similar with or without further intraoperative SLN identification with blue dye (98.8% vs 98.17%, P > 0.05). Time to procedure was not associated with higher SLN positivity rate (P > 0.05). In univariate analysis, Breslow thickness (P < 0.001), primary ulceration lesion (P = 0.001), and lymphovascular invasion (P = 0.006) were strongly correlated with SLN positivity, as well as the site of primary tumor (P = 0.024), tumor-infiltrating lymphocytes (TILs) (P = 0.021), and sex (P = 0.026). In multivariate analysis, Breslow thickness and TILs were found to be significant independent predictors of SLN status (P < 0.05). CONCLUSIONS Addition of blue dye did not improve SLN detection rate; time to procedure was not found to be associated with higher SLN biopsy positivity rates. Breslow thickness and TILs, as a marker of immune response to tumor, were consistently found to be significant independent predictors of SLN status.
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Affiliation(s)
| | | | | | | | | | | | - Nenad Petrov
- Institute of Pathology and Forensic Medicine Interdisciplinary Melanoma Team, Military Medical Academy, Belgrade, Serbia
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26
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Eiger D, de Oliveira DA, de Oliveira RL, Sousa MC, Brandão MDC, de Oliveira Filho ,RS. Complete lymphadenectomy following positive sentinel lymph node biopsy in cutaneous melanoma: a critical review. An Bras Dermatol 2018; 93:553-558. [PMID: 30066763 PMCID: PMC6063107 DOI: 10.1590/abd1806-4841.20187312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/19/2018] [Indexed: 01/19/2023] Open
Abstract
Cutaneous melanoma is the solid neoplasia with the highest growing incidence among all tumors. It spreads predictably to the lymphatic vessels and sentinel lymph node, and when the latter is affected the prognosis worsens dramatically. Sentinel lymph node biopsy is considered when thickness of the primary tumor exceeds 1mm and/or when there are adverse features in thinner melanomas. When there is nodal metastasis, current evidence in the literature recommends complete lymphadenectomy, although this procedure has its intrinsic risks (i.e., lymphedema and cellulitis), and there are no published clinical trials proving additional overall survival benefits. The current in-depth literature review thus aims to identify patients that will benefit most from the procedure, including those with the highest likelihood of presenting additional affected lymph nodes in the same nodal basin. The authors also discuss techniques for identification of the sentinel lymph node, false-negative rates, and predictive models for lymph node involvement. In conclusion, complete elective lymphadenectomy should always be discussed on a case-by-case basis when metastases are detected in the sentinel lymph node.
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Affiliation(s)
- Daniel Eiger
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Centro Paulista de Oncologia, São Paulo (SP), Brazil
| | - Daniel Arcuschin de Oliveira
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Student Training Program in General Surgery by Colégio
Brasileiro de Cirurgiões, Hospital Stella Maris, Guarulhos (SP), Brazil
| | | | - Murilo Costa Sousa
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Medical Student, Faculdade Santa Marcelina, São Paulo (SP),
Brazil
| | - Mireille Darc Cavalcante Brandão
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Oncogynecology Division, Hospital Santa Marcelina, São Paulo
(SP), Brazil
- Oncology Outpatient Clinic, Hospital Santa Paula, São Paulo
(SP), Brazil
- Department of Oncology, Oncodermatology Division, Hospital 9 de
Julho, São Paulo (SP), Brazil
| | - ,Renato Santos de Oliveira Filho
- Clínica Professor Doutor Renato Santos, São Paulo
(SP), Brazil
- Centro de Oncologia e Hematologia Família Dayan Daycoval,
Hospital Israelita Albert Einstein, São Paulo (SP), Brazil
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27
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Puza CJ, Josyula S, Terando AM, Howard JH, Agnese DM, Mosca PJ, Lee WT, Beasley GM. Does the number of sentinel lymph nodes removed affect the false negative rate for head and neck melanoma? J Surg Oncol 2018. [PMID: 29513892 DOI: 10.1002/jso.25025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Head and neck (HN) cutaneous melanoma is associated with worse disease-free survival compared to non-HN cutaneous melanoma, possibly due to inadequate staging. We aim to determine if a higher yield of sentinel lymph nodes (SLNs) affected rates of sentinel lymph node biopsy (SLNB) positivity. METHODS Two Cancer Registries were used to identify patients who underwent SLNB for HN melanoma. A false negative (FN) was defined by nodal recurrence after negative SLNB. RESULTS Out of 333 patients who underwent SLNB, 20% (n = 69) had a positive SLN with a FN rate of 6.3%. Those with three or more SLNs had a higher rate of SLN positivity (23.8% [17.5-29.9% CI] vs 16.4% [10.7-23.6% CI]), a lower FN rate (16.7% [10.2-21.2% CI] vs 35.3% [27.1-42.9% CI]), and higher sensitivity (83.3% [82.59-84.09% CI] vs 65.7% [64.87-66.53% CI]) compared to those with one or two SLNs. Of patients in Group 1 (one or two SLNs) with a positive SLN who underwent completion lymph node dissection (20/23), 47% (33-61% CI) had one or more positive non-sentinel nodes compared to 29% (16-51%) of patients in Group 2 (three or more SLNs) (42/46). CONCLUSION In HN melanoma cases in which multiple nodes are identified, removal of all SLNs will more adequately stage patients.
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Affiliation(s)
- Charles J Puza
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Srirama Josyula
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Alicia M Terando
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - John H Howard
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Doreen M Agnese
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Paul J Mosca
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Walter T Lee
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Georgia M Beasley
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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28
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Trinh BB, Chapman BC, Gleisner A, Kwak JJ, Morgan R, McCarter MD, Gajdos C, Kounalakis N. SPECT/CT Adds Distinct Lymph Node Basins and Influences Radiologic Findings and Surgical Approach for Sentinel Lymph Node Biopsy in Head and Neck Melanoma. Ann Surg Oncol 2018; 25:1716-1722. [PMID: 29330718 DOI: 10.1245/s10434-017-6298-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Planar lymphoscintigraphy (PL) has a lower detection rate of sentinel lymph nodes (SLNs) in head and neck melanoma compared with other sites. We assessed situations when single-photon emission computed tomography/computed tomography (SPECT/CT) identified nodes not seen by PL. We also evaluated the impact of SPECT/CT on surgical approach and oncologic outcomes. METHODS Patients who underwent SLN biopsy (SLNB) for head and neck melanoma with PL and SPECT/CT between November 2011 and December 2016 were included. Surgeons and radiologists completed a real-time survey inquiring about the utility of SPECT/CT. Patients were divided into two groups: patients with nodal basins identified by both PL and SPECT/CT ('PL + SPECT/CT'), and patients in whom SPECT/CT identified additional nodal basins not seen on PL ('SPECT/CT only'). Patient demographics and long-term outcomes including follow-up duration, recurrence, and survival are described. RESULTS In the PL + SPECT/CT group, 73 (61.9%) patients were included and 45 (38.1%) patients were included in the SPECT/CT-only group. SPECT/CT added 51 basins to those seen on PL, primarily in the supraclavicular region (43.1%). Eighteen patients had positive node(s) in the PL + SPECT/CT group compared with two patients in the SPECT/CT-only group. Surgeons reported that 81% of the time, SPECT/CT influenced the location of incision for SLNB. CONCLUSIONS SPECT/CT influences the location of incision and contributes most to identification of nodes in the supraclavicular region. It also detects additional SLN basins when compared with PL. Further studies are necessary to determine when these additional basins require sampling.
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Affiliation(s)
- Becky B Trinh
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandon C Chapman
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ana Gleisner
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer J Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rustain Morgan
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Martin D McCarter
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Csaba Gajdos
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Kounalakis
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
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Determining the False-Negative Rate Using Fluorescence Image–Assisted Sentinel Lymph Node Biopsy in Cutaneous Melanoma. Ann Plast Surg 2018; 80:54-58. [DOI: 10.1097/sap.0000000000001211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sibley R, Subramaniam RM. SPECT/CT: Looking Beyond Sentinel Lymph Node Identification for Improving Patient Outcomes. Ann Surg Oncol 2017; 25:1467-1468. [PMID: 29218428 DOI: 10.1245/s10434-017-6301-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Robert Sibley
- Division of Nuclear Medicine, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rathan M Subramaniam
- Division of Nuclear Medicine, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Harold Simmons Comprehensive Cancer Center, University of Texax Southwestern Medical Center, Dallas, TX, USA.
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Sinnamon AJ, Neuwirth MG, Bartlett EK, Zaheer S, Etherington MS, Xu X, Elder DE, Czerniecki BJ, Fraker DL, Karakousis GC. Predictors of false negative sentinel lymph node biopsy in trunk and extremity melanoma. J Surg Oncol 2017. [PMID: 28650537 DOI: 10.1002/jso.24743] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nodal recurrence following negative sentinel lymph node biopsy (SLNB) for melanoma is known as false-negative (FN) SLNB. Risk factors for FN SLNB among patients with trunk and extremity melanoma have not been well-defined. METHODS After retrospective review, SLNB procedures were classified FN, true positive (TP; positive SLNB), or true negative (TN; negative SLNB without recurrence). Factors associated with high false negative rate (FNR) and low negative predictive value (NPV) were identified by comparing FNs to TPs and TNs, respectively. Survival was evaluated using Kaplan-Meier methods. RESULTS Of 1728 patients, 234 were TP and 37 were FN for overall FNR of 14% and NPV of 97.5%. Age ≥65 years was independently associated with high FNR (FNR 20% in this group). Breslow thickness >1 mm and ulceration were independently associated with low NPV. Among patients with ulcerated tumors >4 mm, NPV was 88%. Median time to recurrence for FNs was 13 months. Among patients with primary melanomas ≤2 mm in depth, overall and distant disease-free survival were significantly shorter with FN SLNB than TP SLNB. CONCLUSIONS Older age is associated with increased FNR; patients with thick, ulcerated lesions should be considered for increased nodal surveillance after negative SLNB given low NPV in this group.
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Affiliation(s)
- Andrew J Sinnamon
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madalyn G Neuwirth
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Edmund K Bartlett
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Salman Zaheer
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark S Etherington
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xiaowei Xu
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E Elder
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian J Czerniecki
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Fraker
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Madu M, Wouters M, van Akkooi A. Sentinel node biopsy in melanoma: Current controversies addressed. Eur J Surg Oncol 2017; 43:517-533. [DOI: 10.1016/j.ejso.2016.08.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022] Open
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Stewart CL, Gleisner A, Kwak J, Chapman B, Pearlman N, Gajdos C, McCarter M, Kounalakis N. Implications of Sentinel Lymph Node Drainage to Multiple Basins in Head and Neck Melanoma. Ann Surg Oncol 2017; 24:1386-1391. [DOI: 10.1245/s10434-016-5744-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Indexed: 11/18/2022]
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Rubinstein JC, Han G, Jackson L, Bulloch K, Ariyan S, Narayan D, Rothberg BG, Han D. Regression in thin melanoma is associated with nodal recurrence after a negative sentinel node biopsy. Cancer Med 2016; 5:2832-2840. [PMID: 27671840 PMCID: PMC5083736 DOI: 10.1002/cam4.922] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 02/06/2023] Open
Abstract
Prognostic markers for nodal metastasis in thin melanoma patients are debated. We present a single institution study looking at factors predictive of nodal disease in thin melanoma patients. Retrospective review from 1997 to 2012 identified 252 patients with thin melanoma (≤1 mm) who underwent a sentinel lymph node biopsy (SLNB). Node‐positive patients included positive SLNB patients and negative SLNB patients who developed a nodal recurrence (false‐negative SLNB). Clinicopathologic characteristics were correlated with nodal status and outcome. Median follow‐up was 45.5 months. Twelve of 252 patients (4.8%) were node‐positive including six positive SLNB (2.4%) and six false‐negative SLNB (2.4%) patients. No clinicopathologic factors were significantly correlated with nodal disease. For the six false‐negative SLNB patients, median time to nodal recurrence was 37.5 months. Regression was seen in only 16% of cases, but the rate increased to 60% for false‐negative SLNB cases. Both age (odds ratio [OR]: 1.09, 95% CI: 1.01–1.17; P = 0.02) and regression (OR: 8.33, 95% CI: 1.34–52.63; P = 0.02) were significantly associated with nodal recurrence after a negative SLNB on univariable analysis. Nodal disease in thin melanoma patients was seen in 4.8% of cases. Although regression was not correlated with nodal metastasis, it was correlated with a false‐negative SLNB. Patients with thin melanoma and regression may need more intensive surveillance after a negative SLNB. Further study is needed to determine if the same immune mechanisms that result in regression in primary tumors also lead to regression in lymph nodes, which may decrease detection of melanoma nodal metastases.
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Affiliation(s)
- Jill C Rubinstein
- Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Gang Han
- Department of Epidemiology & Biostatistics, Texas A&M, College Station, Texas, 77843
| | - Laura Jackson
- Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Kaleigh Bulloch
- Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Stephan Ariyan
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Deepak Narayan
- Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Bonnie G Rothberg
- Medical Oncology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, 06520
| | - Dale Han
- Section of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, 06520.
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Measuring the quality of melanoma surgery - Highlighting issues with standardization and quality assurance of care in surgical oncology. Eur J Surg Oncol 2016; 43:561-571. [PMID: 27422583 DOI: 10.1016/j.ejso.2016.06.397] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/09/2016] [Accepted: 06/18/2016] [Indexed: 01/21/2023] Open
Abstract
In an attempt to ensure high standards of cancer care, there is increasing interest in determining and monitoring the quality of interventions in surgical oncology. In recent years, this has been particularly the case for melanoma surgery. The vast majority of patients with melanoma undergo surgery. Usually, this is with combinations of wide excision, sentinel lymph node biopsy and lymphadenectomy. The indications for these procedures evolved during a time when no effective systemic adjuvant therapy was available, and whilst the rationale has been sound, the justification for differences in extent and thoroughness has generally been supported by inadequate or low-level evidence. This has led to a substantial variation among melanoma centres or even among surgeons within a centre in how these procedures are done. With recent rapid progress in the efficacy of systemic treatments that are impacting on overall survival, the prospect of long-term survival in these previously high risk patients means that more than ever long-term locoregional control of melanoma is imperative. Furthermore, the understanding of effects of systemic therapy on locoregional disease will only be interpretable if surgeons use standardized, high quality techniques. This article focuses on standardization and evolution of quality indicators for melanoma surgery and how these might have a positive impact on patient care.
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