Advertisement

Annals of Surgical Oncology

, Volume 14, Issue 12, pp 3566–3574 | Cite as

Sentinel Lymph Node Biopsy in Cutaneous Melanoma: A Case-Control Study

  • Ilkka Koskivuo
  • Lauri Talve
  • Pia Vihinen
  • Maija Mäki
  • Tero Vahlberg
  • Erkki Suominen
Melanomas Original Paper

Abstarct

Background

Sentinel lymph node biopsy (SLNB) is the most precise method for staging invasive cutaneous melanoma, but its therapeutic effect has been difficult to assess, and SLNB is not routinely used in all melanoma treatment centers.

Methods

This case-control study of 305 prospective SLNB patients compared them with 616 retrospective patients who had not undergone invasive nodal staging at diagnosis. Thin melanomas were included in both study groups.

Results

A total of 50 SLNB patients were sentinel positive (16.4%) and 255 were sentinel negative (83.6%). A total of 49 of the 50 sentinel-positive patients underwent completion lymph node dissection, and 9 of them (18%) had additional metastases in the nonsentinel nodes. The false-negative rate was 1.6% (five same-basin nodal recurrences during follow-up). There was a significant difference in melanoma-related overall survival (OS) between sentinel-positive and sentinel-negative patients (P < .001). The tumor burden of the sentinel nodes was a significant prognostic factor for melanoma-related OS (P < .001). There was no significant difference in melanoma-related OS or disease-free survival between the study groups, but the nodal disease-free survival was significantly longer among the SLNB patients (P = .004).

Conclusions

SLNB is recommended for routine use in the treatment of cutaneous melanoma because the sentinel node status carries unique prognostic information on the survival of melanoma patient. Improved regional disease control is an obvious therapeutic advantage of SLNB and immediate completion lymph node dissection.

Keywords

Melanoma Sentinel lymph node Recurrence Prognosis 

References

  1. 1.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9PubMedGoogle Scholar
  2. 2.
    Gershenwald JE, Thompson W, Mansfield, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol 1999;17:976–83Google Scholar
  3. 3.
    Cascinelli N, Belli F, Santinami M, et al. Sentinel lymph node biopsy in cutaneous melanoma: the WHO Melanoma Program experience. Ann Surg Oncol 2000;7:469–74PubMedCrossRefGoogle Scholar
  4. 4.
    Essner R. Experimental frontiers for clinical applications: novel approaches to understanding mechanisms of lymph node metastases in melanoma. Cancer Metastasis Rev 2006;25:257–67PubMedCrossRefGoogle Scholar
  5. 5.
    Leong SP, Cady B, Jablons DM, et al. Clinical patterns of metastasis. Cancer Metastasis Rev 2006;25:221–32PubMedCrossRefGoogle Scholar
  6. 6.
    Balch CM, Buzaid AC, Soong SJ, et al. Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. J Clin Oncol 2001;19:3635–48PubMedGoogle Scholar
  7. 7.
    Starz H, Balda BR, Kramer KU, Buchels H, Wang HA. micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma. Cancer 2001;91:2110–21PubMedCrossRefGoogle Scholar
  8. 8.
    Dewar DJ, Newell B, Green MA, Topping AP, Powell BW, Cook MG. The microanatomic location of metastatic melanoma in sentinel lymph nodes predicts nonsentinel lymph node involvement. J Clin Oncol 2004;22:3345–9PubMedCrossRefGoogle Scholar
  9. 9.
    Thomas JM. Caution with sentinel node biopsy in cutaneous melanoma. Br J Surg 2006;93:129–30PubMedCrossRefGoogle Scholar
  10. 10.
    Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006;355:1307–17PubMedCrossRefGoogle Scholar
  11. 11.
    Gutzmer R, Al Ghazal M, Geerlings H, Kapp A. Sentinel node biopsy in melanoma delays recurrence but does not change melanoma-related survival: a retrospective analysis of 673 patients. Br J Dermatol 2005;153:1137–41PubMedCrossRefGoogle Scholar
  12. 12.
    Kettlewell S, Moyes C, Bray C, et al. Value of sentinel node status as a prognostic factor in melanoma: prospective observational study. BMJ 2006;332:1423–7PubMedCrossRefGoogle Scholar
  13. 13.
    Starz H, Siedlecki K, Balda BR. Sentinel lymphonodectomy and S-classification: a successful strategy for better prediction and improvement of outcome of melanoma. Ann Surg Oncol 2004;11:162S–8SPubMedGoogle Scholar
  14. 14.
    Kretschmer L, Hilgers R, Mohrle M, et al. Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease. Eur J Cancer 2004;40:212–8PubMedCrossRefGoogle Scholar
  15. 15.
    Agnese DM, Abdessalam SF, Burak WE Jr, Magro CM, Pozderac RV, Walker MJ. Cost-effectiveness of sentinel lymph node biopsy in thin melanomas. Surgery 2003;134:542–7PubMedCrossRefGoogle Scholar
  16. 16.
    Stitzenberg KB, Groben PA, Stern SL, Thomas NE, Hensing TA, Sansbury LB, Ollila DW. Indications for lymphatic mapping and sentinel lymphadenectomy in patients with thin melanoma (Breslow thickness ≤1.0 mm). Ann Surg Oncol 2004;11:900–6PubMedCrossRefGoogle Scholar
  17. 17.
    Koskivuo I, Suominen E, Niinikoski J, Talve L. Sentinel node metastasectomy in thin ≤1-mm melanoma. Langenbecks Arch Surg 2005;390:403–7PubMedCrossRefGoogle Scholar
  18. 18.
    McMasters KM, Wong SL, Edwards MJ, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol 2002;9:137–41PubMedCrossRefGoogle Scholar
  19. 19.
    Roka F, Mastan P, Binder M, et al. Prediction of non–sentinel node status and outcome in sentinel node–positive melanoma patients. Eur J Surg Oncol doi: 10.1016/j.ejso.2007.01.027
  20. 20.
    Cochran AJ, Wen DR, Huang RR, Wang HJ, Elashoff R, Morton DL. Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node. Mod Pathol 2004;17:747–55PubMedCrossRefGoogle Scholar
  21. 21.
    Carlson GW, Murray DR, Lyles RH, Staley CA, Hestley A, Cohen C. The amount of metastatic melanoma in a sentinel lymph node: does it have prognostic significance? Ann Surg Oncol 2003;10:575–81PubMedCrossRefGoogle Scholar
  22. 22.
    Satzger I, Völker B, Al Ghazal M, Meier A, Kapp A, Gutzmer R. Prognostic significance of histopathological parameters in sentinel nodes of melanoma patients. Histopathology 2007;50:764–72PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2007

Authors and Affiliations

  • Ilkka Koskivuo
    • 1
  • Lauri Talve
    • 2
  • Pia Vihinen
    • 3
  • Maija Mäki
    • 4
  • Tero Vahlberg
    • 5
  • Erkki Suominen
    • 1
  1. 1.Department of SurgeryTurku University HospitalTurkuFinland
  2. 2.Department of PathologyTurku University HospitalTurkuFinland
  3. 3.Department of Oncology and RadiotherapyTurku University HospitalTurkuFinland
  4. 4.Department of Nuclear MedicineTurku University HospitalTurkuFinland
  5. 5.Department of BiostatisticsTurku UniversityTurkuFinland

Personalised recommendations