Complete lymph node dissection or observation in melanoma patients with multiple positive sentinel lymph nodes: A single-center retrospective analysis

Sentinel lymph node biopsy has been demonstrated to be an effective staging procedure since its introduction in 1992. The new American Joint Committee on Cancer (AJCC) classification did not consider the lack of information that would result from the less usage of the complete lymph node dissection as for a diagnostic purpose. Thus, this makes it difficult the correct staging and would leave about 20% of the further positive non-sentinel lymph nodes in the lymph node basin. In this paper, we aim to describe a new surgical technique that, combined with single-photon emission computed tomography—computed tomography (SPECT-CT), allows for better staging of melanoma patients. This is a prospective study that includes 104 patients with cutaneous melanoma. Sentinel lymph node biopsy was offered according to the AJCC guideline. Planar lymphoscintigraphy was performed in association with SPECT-CT, identifying and removing all non-biologically “excluded” lymph nodes, guiding the surgeon’s hand in detection and removal of lymph nodes. Even if identification and removal of non-sentinel lymph nodes is unable to increase overall survival, it definitely gives better disease control in the basin. With a “classic” setting, the risk of leaving further lymph nodes out of the sentinel lymph node procedure is around 20%, thus, basically, the surgical sentinel lymph node of first and second lymph nodes would have therapeutic value and complete lymph node dissection classically performed.

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Letter: Completion lymph node dissection in melanoma patients with positive sentinel lymph nodes: Authors' reply

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2013.07.005 ◽

2013 ◽

Vol 39 (10) ◽

pp. 1166

Author(s):

V. Nagaraja ◽

G.D. Eslick

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Sentinel Lymph Nodes ◽

Completion Lymph Node Dissection ◽

Node Dissection ◽

Melanoma Patients

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Completion lymph node dissection in melanoma patients with positive sentinel lymph nodes

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2013.07.006 ◽

2013 ◽

Vol 39 (10) ◽

pp. 1164-1165 ◽

Cited By ~ 1

Author(s):

R. Murali ◽

R.A. Scolyer ◽

J.F. Thompson

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Sentinel Lymph Nodes ◽

Completion Lymph Node Dissection ◽

Node Dissection ◽

Melanoma Patients

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Laparoscopic detection of sentinel lymph nodes followed by lymph node dissection in patients with early stage cervical cancer

Gynecologic Oncology ◽

10.1016/s0090-8258(03)00277-4 ◽

2003 ◽

Vol 90 (2) ◽

pp. 290-296 ◽

Cited By ~ 80

Author(s):

Marrije R Buist ◽

Rik J Pijpers ◽

Arthur van Lingen ◽

Paul J van Diest ◽

Jan Dijkstra ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Dissection ◽

Early Stage ◽

Sentinel Lymph Nodes ◽

Node Dissection ◽

Early Stage Cervical Cancer

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Abstract P2-01-20: The ratio and size of positive sentinel lymph nodes predicts the involvement of non-sentinel lymph nodes following completion axillary lymph node dissection

10.1158/1538-7445.sabcs14-p2-01-20 ◽

2015 ◽

Author(s):

Rajiv V Dave ◽

Muhhamed N Chauhan ◽

Maria Ghaus ◽

Sana Ahmed ◽

Shiv Shapra ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Axillary Lymph Node Dissection ◽

Lymph Node Dissection ◽

Axillary Lymph Node ◽

Sentinel Lymph Nodes ◽

Axillary Lymph ◽

Node Dissection

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Survival of SLNB-positive melanoma patients with and without complete lymph node dissection: A multicenter, randomized DECOG trial.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.18_suppl.lba9002 ◽

2015 ◽

Vol 33 (18_suppl) ◽

pp. LBA9002-LBA9002 ◽

Cited By ~ 9

Author(s):

Ulrike Leiter ◽

Rudolf Stadler ◽

Cornelia Mauch ◽

Werner Hohenberger ◽

Norbert Brockmeyer ◽

...

Keyword(s):

Lymph Node ◽

Lymph Node Dissection ◽

Distant Metastases ◽

Tumor Burden ◽

Phase Iii ◽

Node Dissection ◽

Significant Treatment ◽

Melanoma Patients ◽

Complete Lymph Node Dissection

LBA9002 Background: Complete lymph node dissection (CLND) following positive sentinel node biopsy (SLNB) was evaluated in a randomized phase III trial. Methods: 1,258 patients with cutaneous melanoma of the trunk and extremities and with positive SLNB were evaluated. Of these, 483 (39%) agreed to randomization into the clinical trial. 241 patients underwent observation only, 242 received CLND. Both groups had a subsequent 3-years follow-up. Recurrence-free (RFS), distant metastases free (DMFS) and melanoma specific (MSS) survival were analyzed as endpoints. Results: Patient enrolment was performedfrom January 2006 to December 2014. In the intent to treat analysis, both groups did not differ significantly in distribution of age, gender, localization, ulceration, tumor thickness (median 2,4 mm in both groups), number of positive nodes, or tumor burden in the SN. The mean follow-up time was 34 months (SD ± 22.1). No significant treatment-related difference was seen in the 5-years RFS (P = 0.72), DMFS (P= 0 .76) and MSS (P = 0.86) in the overall study population. Conclusions: In this early analysis of trial results, no survival benefit was achieved by CLND in melanoma patients with positive SLNB. A subsequent analysis three years after inclusion of the last patient is planned.

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