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Sentinel lymph node biopsy for conjunctival malignant melanoma: surgical techniques
Alberto Ja Wainstein1, Ana P Drummond-Lage2, Milhem Jm Kansaon3
1Faculty of Medical Sciences of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil ; Oncad Surgical Oncology, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Clinical Ophthalmology (Auckland, N.Z.)
|January 8, 2015
Summary
Preoperative lymphoscintigraphy and sentinel lymph node (SLN) biopsy are safe and effective for conjunctival melanoma. This dual-tracer technique accurately identifies SLNs, ensuring accurate staging and good patient outcomes.
Area of Science:
- Ophthalmology
- Surgical Oncology
- Nuclear Medicine
Background:
- Conjunctival melanoma is a rare but potentially aggressive ocular malignancy.
- Accurate staging is crucial for effective treatment and prognosis.
- Sentinel lymph node (SLN) biopsy is a key diagnostic tool for melanoma staging.
Purpose of the Study:
- To evaluate the safety and efficacy of preoperative lymphoscintigraphy and SLN biopsy for conjunctival melanoma.
- To determine the optimal technique for performing this procedure.
Main Methods:
- Three patients with conjunctival melanoma underwent SLN biopsy using a dual technique: isosulfan blue dye and technetium Tc 99m sulfur colloid.
- SLNs were localized using a gamma probe and identified by radioactivity and blue staining.
- Pathological evaluation included H&E staining and immunohistochemistry for melanoma markers.
Main Results:
- Preoperative lymphoscintigraphy accurately identified SLNs in all three patients (100% accuracy).
- All identified SLNs were successfully dissected and confirmed histopathologically.
- No evidence of melanoma metastasis was found in the SLNs, and patients experienced good cosmetic and functional outcomes with preserved visual acuity.
Conclusions:
- Preoperative lymphoscintigraphy combined with SLN biopsy is a safe and viable procedure for conjunctival melanoma.
- The dual-tracer technique (radioactive technetium and isosulfan blue dye) facilitates accurate SLN identification and dissection.
- This approach aids in accurate staging and can lead to favorable patient outcomes.
