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Is pelvic sentinel node biopsy necessary for lower extremity and trunk melanomas?
Darryl Schuitevoerder1, Stanley P L Leong2, Jonathan S Zager3
1Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
American Journal of Surgery
|April 17, 2017
Summary
Pelvic sentinel lymph node (PSLN) biopsy in melanoma is safe. It has minimal impact if superficial lymph nodes are negative, but is recommended if they are positive or if the tumor exclusively drains to PSLNs.
Area of Science:
- Oncology
- Dermatology
- Surgical Oncology
Background:
- Melanoma management requires precise staging.
- Sentinel lymph node biopsy (SLNB) is crucial for staging melanoma.
- The role of pelvic sentinel lymph nodes (PSLNs) in melanoma remains unclear.
Purpose of the Study:
- To determine the incidence of PSLN involvement in melanoma.
- To evaluate the clinical impact of PSLN biopsy.
- To establish consensus on PSLN management in melanoma.
Main Methods:
- Retrospective analysis of a multi-institutional melanoma database.
- Inclusion of 2476 cases with lower extremity and trunk melanomas.
- Comparison of complication rates between PSLN and superficial sentinel lymph node (SSLN) biopsy.
Main Results:
- 9% of melanomas (227/2476) drained to PSLNs.
- 7.5% of PSLN-positive cases (17/227) had nodal metastasis.
- PSLN biopsy had minimal impact when SSLNs were negative, with only 0.6% upstaged.
Conclusions:
- PSLN biopsy is a safe procedure.
- PSLN biopsy offers minimal clinical benefit when superficial sentinel lymph nodes (SSLNs) are negative.
- Recommend PSLN biopsy for positive SSLNs or exclusive drainage to PSLNs.