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Regional nodal basin control is not compromised by previous sentinel lymph node biopsy in patients with melanoma
J E Gershenwald1, R S Berman, G Porter
1Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Background:
Regional nodal basin control is an important goal of lymphadenectomy in the management of melanoma patients with nodal disease. The purpose of this study was to determine if previous sentinel lymph node (SLN) biopsy compromises the ultimate regional nodal control achieved by subsequent therapeutic lymph node dissection in melanoma patients with microscopic lymph node metastases.
Methods:
A surgical melanoma database and hospital records were reviewed for 602 patients with primary cutaneous melanoma who underwent successful lymphatic mapping and SLN biopsy between 1991 and 1997.
Results:
A total of 105 (17%) of 602 patients had histologically positive SLNs and were offered therapeutic lymphadenectomy; 101 (96%) underwent this procedure. Thirty-six patients (36%) developed recurrent melanoma at one or more sites. The median follow-up period was 30 months. Recurrence in the previously dissected nodal basin was observed in 10 patients (10%); none had recurrence at only that site. Nodal basin disease appeared after local/in-transit (n = 6) or distant (n = 1) failure in seven patients and, as a component of the first site of failure, simultaneously with local/in-transit (n = 2) or distant (n = 1) recurrence in three patients.
Conclusions:
Nodal basin failure after lymphadenectomy in patients who underwent previous biopsy of a histologically positive SLN is primarily a function of aggressive locoregional disease rather than of contamination from previous surgery. Because regional nodal control was comparable with that in other series, we conclude that SLN biopsy with selective lymphadenectomy does not compromise regional nodal basin control.
Insights
Sentinel lymph node (SLN) biopsy followed by therapeutic lymphadenectomy does not compromise regional nodal basin control in melanoma patients. Recurrence is linked to aggressive disease, not surgical contamination from the initial SLN biopsy.
Area of Science:
- Oncology
- Surgical Oncology
- Dermatology
Background:
- Regional nodal basin control is critical in managing melanoma with nodal disease.
- Sentinel lymph node (SLN) biopsy is a key staging procedure.
- The impact of prior SLN biopsy on subsequent lymphadenectomy outcomes requires investigation.
Purpose of the Study:
- To determine if prior sentinel lymph node (SLN) biopsy compromises regional nodal control after therapeutic lymph node dissection in melanoma patients.
- To assess the relationship between SLN biopsy and subsequent nodal basin failure.
Main Methods:
- Retrospective review of a surgical melanoma database and hospital records.
- Analysis of 602 patients with primary cutaneous melanoma who underwent SLN biopsy between 1991 and 1997.
- Evaluation of outcomes for 101 patients who proceeded to therapeutic lymphadenectomy after positive SLN biopsy.
Main Results:
- Of 602 patients, 105 (17%) had positive SLNs and underwent therapeutic lymphadenectomy.
- 36% of patients developed recurrent melanoma; 10% experienced recurrence within the previously dissected nodal basin.
- Nodal basin recurrence was often associated with or occurred after local/in-transit or distant failure, suggesting aggressive disease.
Conclusions:
- Nodal basin failure post-lymphadenectomy in patients with prior positive SLN biopsy is primarily due to aggressive locoregional disease.
- Sentinel lymph node biopsy with selective lymphadenectomy does not compromise regional nodal basin control.
- Regional nodal control achieved is comparable to other reported series, supporting the safety of the SLN approach.