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Patients with sentinel lymph node positive melanoma: Who needs completion lymph node dissection?

Darryl Schuitevoerder1, Irvan Bubic2, Jeanine Fortino3

  • 1Oregon Health & Science University, Department of Surgery, Portland, OR, USA.

American Journal of Surgery
|February 6, 2018
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Summary

Predictors of non-sentinel node (NSN) positivity in melanoma patients include tumor thickness and lymph node basin location. This information can help identify patients who may benefit from completion lymph node dissection (CLND).

Keywords:
Completion lymph node dissectionMelanomaNon-sentinel lymph nodeSentinel node

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Area of Science:

  • Oncology
  • Surgical Pathology
  • Melanoma Research

Background:

  • Completion lymph node dissection (CLND) after positive sentinel lymph node biopsy (SLNB) improves regional but not overall melanoma survival.
  • Most patients with positive SLNB do not have further nodal disease, questioning the universal benefit of CLND.

Purpose of the Study:

  • To identify predictors of non-sentinel node (NSN) positivity in melanoma patients.
  • To guide the selection of patients who may benefit from CLND.

Main Methods:

  • Retrospective review of prospectively collected data.
  • Analysis of melanoma patients who underwent SLNB and CLND.

Main Results:

  • 17.6% of patients had NSN positivity.
  • Tumor thickness (OR 1.2) and nodal basin location (cervical/inguinofemoral 40% vs. axilla 18%) predicted NSN metastasis.
  • More nodes were harvested in NSN-positive cases (20 vs. 13).

Conclusions:

  • Tumor thickness and nodal basin are significant predictors of NSN metastasis.
  • These factors can help personalize the decision for CLND.
  • Inadequate node harvesting in CLND may miss residual disease.