Outcome of patients with melanoma and histologically negative sentinel lymph nodes: one institution's experience

Since its introduction by Morton in 1992, sentinel lymph node (SLN) biopsy has become a standard procedure in the staging and treatment of primary melanoma and clinically negative regional lymph nodes. The primary aims of this procedure are to ascertain the individual lymphatic drainage patterns of primary tumors towards 1 or more different lymph node basins and to identify patients with micrometastatic lymphatic disease for selective lymphadenectomy. The aim of our study was to evaluate over time a cohort of patients who, having undergone SLN treatment, were found negative for metastases using routine histopathological and immunohistochemical analyses.

We studied 102 consecutive patients who underwent intraoperative lymphatic mapping at the Department of Plastic Surgery, University of Florence, Italy, for cutaneous melanoma and were found negative for metastatic melanoma in their SLNs using routine histopathological and immunohistochemical techniques.

Of 102 patients with 103 cutaneous melanomas that underwent SLN resection and proved histologically negative to metastasis in that site, 15 patients (14.7%) developed melanoma recurrence during follow-up.

The diagnostic and prognostic value of the absence of melanoma metastases in SLNs may be limited and not particularly significant, since satellite and in-transit metastases or direct distant metastases will not be detected and hematogenous spread may already have begun at the time of intervention.