1243 Sentinel Lymph Node Biopsy for Melanoma during the COVID-19 Pandemic

Abstract Aim Sentinel lymph node biopsy (SLNB) is an established aspect of the staging process for primary melanoma, with the results dictating future treatment methods. Due to the COVID-19 pandemic no SLNBs were offered to patients with newly diagnosed melanoma at a hospital site in the West Midlands. The aim of this study was to identify the number of patients who missed out on this investigation in order to ascertain how many patients with a potential positive SLNB were missed. Method A patient list was provided from the dermatology and plastic surgery database, ensuring that all newly diagnosed melanoma patients throughout the period March-May 2020 were included. A retrospective study design was utilised, with all data collected from the computer system at a single hospital site. Results 64 patients were provided via the patient list, of which 44 were appropriate for SLNB using the NICE criteria. After detailed reading of the patient notes, 80% (35/44) of patients were provided with a reason why they did not receive a SLNB, however the remaining 20% (9/44) did not have this clearly recorded. Conclusions A large cohort of patients did not receive a SLNB during the COVID-19 pandemic. Utilising the clinical literature, it can be predicted that around 9 of these patients would have had a SLNB that identified metastasis. These patients have potentially missed out on adjuvant treatment, and the cohort will therefore require follow up to be adapted to reflect this.

Download Full-text

Leg swelling after inguinal sentinel lymph node biopsy and primary melanoma excision with a safety margin

JDDG Journal der Deutschen Dermatologischen Gesellschaft ◽

10.1111/j.1610-0387.2012.07941.x ◽

2012 ◽

Vol 10 (10) ◽

pp. 733-738

Author(s):

Lutz Kretschmer ◽

Aila Luise Pratsch

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Safety Margin ◽

Primary Melanoma ◽

Lymph Node Biopsy ◽

Node Biopsy

Download Full-text

Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma

Cancer ◽

10.1002/cncr.22320 ◽

2006 ◽

Vol 107 (11) ◽

pp. 2647-2652 ◽

Cited By ~ 63

Author(s):

Christopher J. Gannon ◽

Dennis L. Rousseau ◽

Merrick I. Ross ◽

Marcella M. Johnson ◽

Jeffrey E. Lee ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Local Excision ◽

Wide Local Excision ◽

Lymphatic Mapping ◽

Primary Melanoma ◽

Lymph Node Biopsy ◽

Node Biopsy

Download Full-text

Evidence-Based Clinical Practice Guidelines on the Use of Sentinel Lymph Node Biopsy in Melanoma

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2013.33.e320 ◽

2013 ◽

pp. e320-e325

Author(s):

Vernon K. Sondak ◽

Sandra L. Wong ◽

Jeffrey E. Gershenwald ◽

John F. Thompson

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Sentinel Node ◽

Primary Melanoma ◽

Lymph Node Biopsy ◽

Evidence Based ◽

Node Negative ◽

Nodal Basin ◽

Node Biopsy

Sentinel lymph node biopsy (SLNB) was introduced in 1992 to allow histopathologic evaluation of the “sentinel” node, that is, the first node along the lymphatic drainage pathway from the primary melanoma. This procedure has less risk of complications than a complete lymphadenectomy, and if the sentinel node is uninvolved by tumor the likelihood a complete lymphadenectomy would find metastatic disease in that nodal basin is very low. SLNB is now widely used worldwide in the staging of melanoma as well as breast and Merkel cell carcinomas. SLNB provides safe, reliable staging for patients with clinically node-negative melanomas 1 mm or greater in thickness, with an acceptably low rate of failure in the sentinel node-negative basin. Evidence-based guidelines jointly produced by ASCO and the Society of Surgical Oncology (SSO) recommend SLNB for patients with intermediate-thickness melanomas and also state that SLNB may be recommended for patients with thick melanomas. Major remaining areas of uncertainty include the indications for SLNB in patients with thin melanomas, pediatric patients, and patients with atypical melanocytic neoplasms; the optimal radiotracers and dyes for lymphatic mapping; and the necessity of complete lymphadenectomy in all sentinel node-positive patients.

Download Full-text

Sentinel Lymph Node Biopsy in Head and Neck Cutaneous Malignant Melanoma

Revista da Sociedade Portuguesa de Dermatologia e Venereologia ◽

10.29021/spdv.77.2.1055 ◽

2019 ◽

Vol 77 (2) ◽

pp. 129-133

Author(s):

Ana Marta António ◽

Cecília Moura ◽

Carina Semedo ◽

Sandra Bitoque ◽

Mariluz Martins ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Head And Neck ◽

Cutaneous Melanoma ◽

Primary Melanoma ◽

Lymph Node Biopsy ◽

Superficial Spreading ◽

Node Biopsy ◽

Head And Neck Melanoma

Introduction: Sentinel lymph node biopsy (SLNB) is the standard of care for cutaneous melanoma, including head and neck melanoma. The aim of this study was to analyze and characterize SLNB in a population of head and neck melanoma patients. Methods: A unicentric, retrospective study on patients with cutaneous head and neck melanoma who underwent SLNB in the Department of Head and Neck Surgery at the Portuguese Institute of Oncology (IPO) Lisbon between January 2010 and December 2017 was performed. The location of primary melanoma, the identification of SLN, the number of the excised SLN, its lymphatic basin origin and the presence of infraclinic metastasis were analysed. Results: Ninety-eight patients were eligible to undergo SLNB during the observation period. The most frequent locations of primary melanoma were the scalp (24.5%) and the auricular and periauricular region (23.5%) and the most frequent variants were the superficial spreading melanoma (40.8%) and nodular melanoma (30.6%). SLNB was successfully executed in 78 patients (79.6%). A mean of 3.8 lymph-nodes per patient were excised and in 16.7% SLN were excised in more than one lymphatic basin. The SLN were identified in parotid region (39.8%), level II (29.5%) and level V (18.2%). SLN metastases were detected in 13 patients (16.7%). Conclusion: Surgical approach of head and neck cutaneous melanoma is particularly complex. The redundancy of lymphatic system, the multiple SLN and SLN basins influence the SLNB success and may contribute to high rates of false-negatives with its prognostic implications. All patients should be carefully monitored.

Download Full-text

Prevalence of sentinel lymph node evaluation in patients with thick primary cutaneous melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19013 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19013-e19013

Author(s):

Abimbola O Olusanya ◽

Dhruvil R Shah ◽

Anthony D Yang ◽

Emanual Maverakis ◽

Robert J. Canter ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Cutaneous Melanoma ◽

Tumor Location ◽

Lymph Node Biopsy ◽

Primary Cutaneous Melanoma ◽

Node Biopsy ◽

Number Of Patients ◽

Lymph Node Evaluation

e19013 Background: Sentinel lymph node biopsy (SLNB) was developed for intermediate thickness melanoma. Its use for thick cutaneous melanoma is controversial. We aimed to report on clinical and pathologic factors associated with the overuse of SLNB for thick primary cutaneous melanoma. Methods: The Surveillance, Epidemiology, and End Results database was queried for patients who underwent surgery for thick primary cutaneous melanoma (known Breslow thickness > 4.00 mm) from 2004 to 2008. We excluded patients with mucosal melanoma, those without a biopsy-proven diagnosis, those diagnosed at autopsy, patients whose lymph node evaluation was unknown or other than SLNB “yes” or SLNB “no”. We used multivariate logistic regression models to predict use of SLNB. Covariates examined included: age sex, race/ethnicity, Breslow depth, tumor histology, tumor location, and ulceration status. Likelihood of undergoing sentinel lymph node biopsy was reported as odds ratios (OR) with 95% confidence intervals (CI); significance was set at p ≤ 0.05. Results: Among 1,981 patients with thick cutaneous melanoma, 1,158 (58.2%) received a SLNB. On multivariate analysis, patients with primary melanomas of the arm (OR 2.07, CI 1.56-2.75; p<0.001), leg (OR 2.40, CI 1.70-3.40; p<0.001) and trunk (OR 1.82, CI 1.38-2.40; p<0.001) had an increased likelihood of receiving a SLNB, as did those with desmoplastic histology (OR 1.47, CI 1.11-1.96; p=0.008). Conclusions: A significant number of patients with thick melanomas receive a SLNB, even though this procedure was not developed for this patient population. We have identified predictors associated with the use of SLNB. These include: arm, leg and trunk primary sites and desmoplastic histology. Further research to assess whether use of SLNB in this population is detrimental or beneficial is needed.

Download Full-text