Popliteal lymphadenectomy for treating metastatic melanoma: case report

CONTEXT: Regional lymph node involvement in patients with malignant melanomas has been associated with poor prognosis. In-transit metastases also lead to poor long-term survival. Whereas for nodal disease only regional lymphadenectomy offers adequate locoregional control, for in-transit metastasis both local excision and isolated limb perfusion with chemotherapy plus tumor necrosis factor-alpha can be used for disease control. In cases of tumors located in the distal region of the legs, the lymphatic dissemination most commonly observed is to the inguinal chain. Consequently, therapeutic inguinal lymphadenectomy or even selective lymphadenectomy (sentinel lymph node biopsy) have been recommended. On the other hand, involvement of the popliteal chain is very rare. When this occurs, popliteal lymphadenectomy should be indicated. Local excision may be the logical approach for a few small in-transit metastases because of the low morbidity in this procedure, when compared with isolated limb perfusion. CASE REPORT: A case of melanoma of the heel with popliteal chain involvement and in-transit metastases is presented. This was treated by means of regional lymphadenectomy plus in-transit metastases excision, with a good postoperative course.

Download Full-text

In-Transit Metastasis from Primary Cutaneous Squamous Cell Carcinoma in a Nonimmunosuppressed Patient

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2014.14047 ◽

2015 ◽

Vol 19 (2) ◽

pp. 167-170 ◽

Cited By ~ 1

Author(s):

Emek Kocatüurk ◽

Pelin Kuteyla Ülkümen ◽

Utkan Kizitaç ◽

Tülin Yüksel ◽

Ayşle Seza Kunter ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Case Report ◽

Lymph Node ◽

High Risk ◽

Malignant Melanoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Regional Lymph Node ◽

Cutaneous Squamous Cell Carcinoma ◽

In Transit

Background In-transit metastases are dermal and subcutanous metastatic foci located between the tumor and the closest regional lymph node. Although in-transit metastasis has been commonly described for malignant melanoma, there have been some reports of in-transit metastases arising from primary cutaneous malignancies. The risk of development of in-transit metastases is higher in patients with high-risk squamous cell carcinoma. Case Report We present a case of in-transit metastasis in a nonimmunosuppressed patient with a primary cutaneous squamous cell carcinoma.

Download Full-text

Isolated limb perfusion for melanoma in-transit metastases: developments in recent years and the role of tumor necrosis factor alpha

Current Opinion in Oncology ◽

10.1097/cco.0b013e3283424dbc ◽

2011 ◽

Vol 23 (2) ◽

pp. 183-188 ◽

Cited By ~ 24

Author(s):

Jan P Deroose ◽

Alexander MM Eggermont ◽

Albertus N van Geel ◽

Cornelis Verhoef

Keyword(s):

Tumor Necrosis Factor ◽

Tumor Necrosis Factor Alpha ◽

Tumor Necrosis ◽

Isolated Limb Perfusion ◽

Necrosis Factor Alpha ◽

Limb Perfusion ◽

Factor Alpha ◽

In Transit ◽

Necrosis Factor

Download Full-text

Prophylactic isolated limb perfusion for localized, high-risk limb melanoma: results of a multicenter randomized phase III trial. European Organization for Research and Treatment of Cancer Malignant Melanoma Cooperative Group Protocol 18832, the World Health Organization Melanoma Program Trial 15, and the North American Perfusion Group Southwest Oncology Group-8593.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.9.2906 ◽

1998 ◽

Vol 16 (9) ◽

pp. 2906-2912 ◽

Cited By ~ 180

Author(s):

H S Koops ◽

M Vaglini ◽

S Suciu ◽

B B Kroon ◽

J F Thompson ◽

...

Keyword(s):

Lymph Node ◽

High Risk ◽

Regional Lymph Node ◽

Phase Iii ◽

World Health ◽

Isolated Limb Perfusion ◽

Primary Cutaneous Melanoma ◽

European Organization ◽

Limb Perfusion ◽

The Impact

PURPOSE Patients with primary cutaneous melanoma > or = 1.5 mm in thickness are at high risk of having regional micrometastases at the time of initial surgical treatment. A phase III international study was designed to evaluate whether prophylactic isolated limb perfusion (ILP) could prevent regional recurrence and influence survival. PATIENTS AND METHODS A total of 832 assessable patients from 16 centers entered the study; 412 were randomized to wide excision (WE) only and 420 to WE plus ILP with melphalan and mild hyperthermia. Median age was 50 years, 68% of patients were female, 79% of melanomas were located on a lower limb, and 47% had a thickness > or = 3 mm. RESULTS Median follow-up duration is 6.4 years. There was a trend for a longer disease-free interval (DFI) after ILP. The difference was significant for patients who did not undergo elective lymph node dissection (ELND). The impact of ILP was clearly on the occurrence-as first site of progression - of in-transit metastases (ITM), which were reduced from 6.6% to 3.3%, and of regional lymph node (RLN) metastases, with a reduction from 16.7% to 12.6%. There was no benefit from ILP in terms of time to distant metastasis or survival. Side effects were higher after ILP, but transient in most patients. There were two amputations for limb toxicity after ILP. CONCLUSION Prophylactic ILP with melphalan cannot be recommended as an adjunct to standard surgery in high-risk primary limb melanoma.

Download Full-text

Lymph node recurrence following stage IA vulvar carcinoma: two cases and a short overview of literature

International Journal of Gynecological Cancer ◽

10.1111/j.1525-1438.2007.00873.x ◽

2007 ◽

Vol 17 (2) ◽

pp. 517-520 ◽

Cited By ~ 7

Author(s):

F. Vernooij ◽

D.M.D.S. Sie-Go ◽

A.P.M. Heintz

Keyword(s):

Case Report ◽

Lymph Node ◽

Local Excision ◽

Lymph Node Metastases ◽

Depth Of Invasion ◽

Vulvar Carcinoma ◽

Term Survival ◽

Adequate Treatment ◽

Stage Ia ◽

Node Metastases

Stage IA vulvar carcinoma is not supposed to metastasize to the lymph nodes. Therefore, it is assumed that these lesions can be safely treated by less aggressive methods than macroinvasive carcinomas. However, in this case report, two patients are described who had vulvar lesions with a depth of invasion of less than 1 mm and developed lymph node metastases in the groin despite radical wide local excision of their lesions. Both the patients underwent lymphadenectomy and received postoperative radiation therapy on the groins. Neither of the two patients died of vulvar carcinoma. Thus, we conclude that vigilance for the occurrence of lymph node metastases remains necessary after radical, local excision in stage IA vulvar cancer. However, this case report also shows that adequate treatment of groin node metastases can result in a very good long-term survival

Download Full-text