Issues arising from the presentation of synchronous cutaneous malignant melanoma and sentinel node biopsies: a case report and discussion

Aims and Background The aims of this study were 1) to investigate whether sentinel lymph node (SLN) biopsy could become the method of choice for the early detection of metastatic disease in patients with malignant melanoma and 2) to identify those patients with lymph node metastases who could benefit from regional lymphadenectomy. Methods and Study Design Our study started in March 1998 and involved 110 patients with primary cutaneous malignant melanoma stage I or II (AJCC) in whom the primary lesion had been surgically removed no more than 90 days previously. On the day of lymph node dissection patients were given an intradermal injection of colloid particles of human serum albumin labeled with technetium-99m and an injection of isosulfan blue. The surgical procedure was usually performed with local anesthesia but in some cases locoregional or general anesthesia was preferred. Contralateral and ipsilateral lymphatic areas were scanned with a hand-held gamma camera (Scintiprobe MR 100) to measure the background and identify the hot point indicating the location of the sentinel node to direct the incision. Results The combined use of lymphoscintigraphy, isosulfan blue and gamma probe allowed us to identify sentinel nodes in 108 of 110 patients (98.18%) while the SLN was blue in only 90 cases (81.81%). The SLN was positive for metastases in 13 of the 108 patients (12.03%) and regional and distal lymphadenectomy was performed in all of them. The distribution of positive SLNs by primary lesion thickness was as follows: 0.76-1.5 mm: one positive SLN/44 patients (2.27%); 1.51-4 mm: six positive SLNs/51 patients (11.7%); >4 mm: six positive SLNs/15 patients (40%). Only four of 12 patients with ulcerated cutaneous melanoma had positive SLNs. The patients in our study underwent follow-up visits every four months. The median follow-up was 481 days (range, 97-1271 days). Conclusions In patients with primary cutaneous melanoma the histological status of the SLN accurately reflects the presence or absence of metastatic disease in the relevant regional lymph node basin. Complete lymph node dissection should only be performed in patients with positive SLNs. Patients with lesions >4 mm are likely to develop recurrences and to die of systemic disease, so in these patients the usefulness of SLN biopsy is questionable. In conclusion, sentinel node mapping is a rational approach for the selection of patients who might benefit from early lymph node dissection of the affected basin.

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Unusual clinical presentation of cutaneous malignant melanoma metastatic to the parotid gland; Initially discovered by fine needle aspiration: Case report and review of literature

Diagnostic Cytopathology ◽

10.1002/dc.21454 ◽

2010 ◽

Vol 39 (5) ◽

pp. 373-376 ◽

Cited By ~ 3

Author(s):

Yasmin Elshenawy ◽

George Youngberg ◽

Mousa A. Al-Abbadi

Keyword(s):

Case Report ◽

Malignant Melanoma ◽

Parotid Gland ◽

Fine Needle Aspiration ◽

Clinical Presentation ◽

Needle Aspiration ◽

Cutaneous Malignant Melanoma ◽

Review Of Literature ◽

Fine Needle

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Re: The metastatic potential of head and neck cutaneous malignant melanoma: is sentinel node biopsy useful?

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2014.06.012 ◽

2014 ◽

Vol 52 (8) ◽

pp. 771

Author(s):

Ben Green ◽

Jenny L.C. Geh

Keyword(s):

Malignant Melanoma ◽

Sentinel Node ◽

Head And Neck ◽

Sentinel Node Biopsy ◽

Metastatic Potential ◽

Cutaneous Malignant Melanoma ◽

Node Biopsy

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Long-Term Survival of Cutaneous Malignant Melanoma with Metastasis to Paranasal Sinuses: A Case Report and Literature Review

Galen Medical Journal ◽

10.31661/gmj.v7i0.860 ◽

2018 ◽

Vol 7 ◽

pp. e860

Author(s):

Kazem Anvari ◽

Mohammad Reza Majidi ◽

Mahdi Razmara Ferezghi ◽

Bahereh Parkam ◽

Seyed Alireza Javadinia

Keyword(s):

Case Report ◽

Malignant Melanoma ◽

Paranasal Sinuses ◽

Cutaneous Malignant Melanoma ◽

The Body ◽

Term Survival ◽

Long Term Survival ◽

Metastatic Setting ◽

Complete Investigation

Background: Malignant melanoma (MM) usually present with metastases to unexpected regions of the body. Metastatic MM is a highly lethal condition, and the median survival in this setting is 6 to 7.5 months; however, few reports rarely describe long-term after chemotherapy.Case Report: We describe a 31-year-old man with MM, which got metastatic (to paranasal sinuses) after local and systemic therapy showed complete responses with long-term survival after endonasal endoscopic metastasectomy and radiotherapy of the nasal cavity, paranasal sinuses, and base of the skull.Conclusion: Although long-term survival is rare, few reports describe cases after chemotherapy. MM could be associated with metastasis to any regions and clinicians should be aware of its behavior and perform complete investigation in the presence of any suspicious symptoms, and this should be reinforced periodically. However, the survival is poor in the metastatic setting, and the treatment of choice is debatable, some patients may benefit from metastasectomy and local radiotherapy. [GMJ.2018;7:e860]

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