eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Sentinel Lymph Node Biopsy in Patients With Melanoma: Follow-up

Author: Nafisa K Kuwajerwala, MD, Staff Surgeon, Breast Oncology, William Beaumont Hospital
Coauthor(s): Amit Dwivedi, MD, Assistant Professor of Surgery, University of Louisville; Thabet Abbarah, MD, FACS, Consulting Staff, Department of Otolaryngology, North Oakland Medical Centers; Dhananjay A Chitale, MBBS, MD, Diagnostic Molecular Pathology Fellow, Memorial Sloan-Kettering Cancer Center; Venkata Subramanian Kanthimathinathan, MD, Staff Physician, Department of General Surgery, Loma Linda University Medical Center
Contributor Information and Disclosures

Updated: May 22, 2008

Outcome and Prognosis

After nodal mapping, regional recurrence rates are acceptably low and the sensitivity and specificity are quite high. In one series, the sensitivity of lymphatic mapping and biopsy of the SLN for lesions on the extremities was 100% and specificity was 97%. Only 3% of subjects with a negative node developed inguinal nodal metastases during a mean 2-year follow-up. This compared favorably with recurrence rates of 4% after ELND. Studies proved that more positive nodes were present with increasing thickness of the primary lesion. The SLN was positive in 16-26% of subjects in various series. Of the nodes found positive after biopsy, 24-33% demonstrated lymph nodes to be involved in CLND. Thus, patients with a positive node could then undergo a CLND.

The median number of SLNs found in several series ranged from 1.3-1.8. Lenisa et al showed that although thickness and ulceration influenced survival in subjects with negative nodes, they provided no additional prognostic information in patients with positive nodes.6 Essner et al first showed that biopsy of the SLN followed by completion lymphadenectomy did not decrease survival compared with subjects undergoing ELND.7 In their series, they matched subjects with clinical stage I melanoma. Half received SLN mapping, and the other half were treated with ELND. The overall prevalences of nodal metastases and survival were no different between the SLN-mapped group and the ELND group, but the prevalence of occult nodal disease was significantly higher among subjects with primary tumors of intermediate thickness who underwent SLN mapping instead of ELND. Thus, they concluded that SLN mapping is therapeutically equivalent but prognostically more accurate than ELND.

Future and Controversies

Selective dissection of the SLN in patients with melanoma is a standard approach for staging primary malignant melanoma and is a team approach with adequately trained surgeons, nuclear medicine physicians, and pathologists. Patients undergoing dissection of the SLN with reverse transcriptase-polymerase chain reaction analysis may be up-staged at the time of diagnosis of their primary melanoma. Such up-staging may result in a lead-time bias. Results from the Sunbelt Melanoma Trial will validate the molecular staging of SLN with reverse transcriptase-polymerase chain reaction.

Several types of melanoma vaccines, including whole cell, peptide, and ganglioside vaccines, have shown promise as adjuvant therapy for stage III disease in nonrandomized and small randomized trials; however, no vaccine has been effective in large randomized controlled trials.

 


More on Sentinel Lymph Node Biopsy in Patients With Melanoma

Overview: Sentinel Lymph Node Biopsy in Patients With Melanoma
Treatment: Sentinel Lymph Node Biopsy in Patients With Melanoma
Follow-up: Sentinel Lymph Node Biopsy in Patients With Melanoma
Multimedia: Sentinel Lymph Node Biopsy in Patients With Melanoma
References
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References

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Further Reading

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Keywords

sentinel lymph node biopsy in patients with melanoma, sentinel lymph node, melanoma, SN, SLN, SLN biopsy, elective lymph node dissection, ELND, complete lymph node dissection, CLND, SLN mapping, sentinel lymph node mapping, therapeutic lymph node dissection, TLND, skin malignancy, skin cancer, skin melanoma, malignant melanoma, skin cancer diagnosis, skin malignancies, sentinel node

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Contributor Information and Disclosures

Author

Nafisa K Kuwajerwala, MD, Staff Surgeon, Breast Oncology, William Beaumont Hospital
Nafisa K Kuwajerwala, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Amit Dwivedi, MD, Assistant Professor of Surgery, University of Louisville
Amit Dwivedi, MD is a member of the following medical societies: American College of Surgeons and American Medical Association
Disclosure: Nothing to disclose.

Thabet Abbarah, MD, FACS, Consulting Staff, Department of Otolaryngology, North Oakland Medical Centers
Thabet Abbarah, MD, FACS is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Dhananjay A Chitale, MBBS, MD, Diagnostic Molecular Pathology Fellow, Memorial Sloan-Kettering Cancer Center
Dhananjay A Chitale, MBBS, MD is a member of the following medical societies: American Society of Clinical Pathologists and College of American Pathologists
Disclosure: Nothing to disclose.

Venkata Subramanian Kanthimathinathan, MD, Staff Physician, Department of General Surgery, Loma Linda University Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Mimi S Kokoska, MD, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences; Chief, Department of Otolaryngology-Head and Neck Surgery, Central Arkansas Veterans Healthcare System
Mimi S Kokoska, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American College of Surgeons, American Head and Neck Society, and Arkansas Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

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