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Selective Sentinel Lymph Node Dissection in Lower Extremity Melanoma.

Suzette G Miranda1, Brian M Parrett, Rui Rachel Li

  • 1San Francisco, Calif. From The Buncke Clinic, California Pacific Medical Center; the Departments of Surgery and Dermatology, University of California, San Francisco; Medivation Biostatistics; and the Center for Melanoma Research & Treatment, California Pacific Medical Center & Research Institute.

Plastic and Reconstructive Surgery
|January 26, 2016
PubMed
Summary

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Sentinel lymph node biopsy for lower extremity melanoma can be guided by drainage patterns. For below-knee melanomas, deep inguinal lymph node biopsy may be deferred if superficial inguinal nodes are positive.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Dermatology

Background:

  • Debate exists regarding the necessity of removing deep inguinal lymph nodes alongside superficial or femoral nodes during sentinel lymph node biopsy for lower extremity melanoma.
  • Preoperative lymphoscintigraphy often identifies both superficial and deep inguinal lymph node basins.

Purpose of the Study:

  • To evaluate lymphatic drainage patterns in lower extremity melanoma.
  • To determine if specific drainage patterns can guide the extent of lymph node dissection, potentially limiting the level of node removal.

Main Methods:

  • Retrospective review of lower extremity melanoma patients undergoing excision and sentinel lymph node biopsy (1995-2010).
  • Analysis of sentinel lymph node drainage basin location, positivity rates, disease-free survival, and overall survival.

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  • Comparison of drainage patterns between melanomas located above and below the knee.

    • Main Results:

    • Of 499 patients, 356 had below-knee and 143 had above-knee melanoma.
    • For below-knee melanoma, sentinel lymph node positivity was 23% superficial inguinal, 0% deep inguinal, and 50% popliteal.
    • Crucially, no patients with negative superficial inguinal sentinel nodes had positive deep inguinal nodes on final pathology.

    Conclusions:

    • Lymphatic drainage patterns differ between melanoma located above and below the knee.
    • Deep inguinal lymph node biopsy may be safely deferred if preoperative lymphoscintigraphy shows simultaneous drainage to the superficial inguinal basin.