Pelvic sentinel lymph node biopsy in melanoma patients: is it worthwhile?

Area of Science:

• Oncology
• Surgical Oncology
• Nuclear Medicine

Background:

• Sentinel node biopsy (SNB) is crucial for melanoma staging.
• Preoperative lymphoscintigraphy (LS) and intraoperative gamma probes improve sentinel node (SN) identification.
• The significance of multiple radioactive nodes detected by gamma probes, particularly deep pelvic nodes, requires further investigation.

Purpose of the Study:

• To evaluate the role of pelvic sentinel node biopsy in patients with recurrent pelvic disease after negative inguinal SNB.
• To assess the impact of deep pelvic "hot spots" identified by LS on melanoma recurrence and survival.

Main Methods:

• Retrospective analysis of 104 stage I/II melanoma patients with primary tumors of the lower limb/trunk.
• Patients with both superficial (inguinal) and deep (iliac-obturator) hot spots on LS were included.
• Follow-up included assessment of pelvic recurrence, disease-free survival, and overall survival.

Main Results:

• 80% of patients had negative inguinal SNs.
• Pelvic recurrence occurred in 2.4% of SN-negative patients.
• 14% of patients with positive pelvic lymph nodes underwent ilioinguinal dissection.
• Disease-free survival was 69% for SN-negative and 53% for SN-positive patients, with no significant difference.

Conclusions:

• Harvesting pelvic sentinel nodes in patients with deep pelvic hot spots on LS may potentially alter the natural history of melanoma.
• Further research with larger sample sizes is needed to confirm the role of pelvic SNB in managing melanoma.
• Improved understanding of pelvic sentinel node behavior could enhance melanoma patient management and outcomes.