scholarly journals Subungual Melanoma: A Single Institution Experience

2021 ◽  
Vol 9 (3) ◽  
pp. 57
Author(s):  
Christopher J. LaRocca ◽  
Lily Lai ◽  
Rebecca A. Nelson ◽  
Badri Modi ◽  
Brooke Crawford
Keyword(s):  
Lymph Node ◽  
Retrospective Chart Review ◽  
Disease Recurrence ◽  
Tumor Location ◽  
Lymph Node Biopsy ◽  
Breslow Thickness ◽  
Histologic Subtype ◽  
Relative Paucity ◽  
Common Histologic Subtype ◽  
Subungual Melanoma

Despite the changing paradigms of melanoma treatment in recent years, there remains a relative paucity of data regarding subungual melanoma in the literature. From 2002–2018, 25 patients with subungual melanoma were surgically treated at our facility. A retrospective chart review was conducted to collect relevant demographic, clinical, pathologic, and outcomes data. The median age at diagnosis was 69 years. Most patients (60%) were male, and the melanoma lesion was most often located on the foot (68%). Acral-lentiginous was the most common histologic subtype (59%), and the median Breslow thickness was 3.4 mm. Fifteen patients (63%) underwent a sentinel lymph node biopsy as part of their surgical resection, and four of these patients (27%) had metastatic disease in the lymph nodes. In total, 10 patients underwent lymph node dissection of the involved basin. The median follow up was 21 months in this patient population. Age, gender, tumor location, ulceration, and lesion histology were not significantly associated with recurrence free survival (RFS). Increasing Breslow thickness was found to be significantly associated with shorter RFS (HR: 1.07, CI: 1.03–1.55). In total, 13 patients developed a disease recurrence, and RFS rates were 66% at 1 year and 40% at 3 years. Additionally, 91 and 37% of patients were alive at one year and three years, respectively. Subungual melanomas are rare lesions that often have a more advanced stage at diagnosis, which contributes to the poor prognosis of these cutaneous malignancies.

Axillary Recurrence is Low in Patients with Breast Cancer who do not Undergo Completion Axillary Lymph Node Dissection for Micrometastases in Sentinel Lymph Nodes

2010 ◽  
Vol 76 (10) ◽  
pp. 1088-1091 ◽  
Author(s):  
Jessica Rayhanabad ◽  
Sara Yegiyants ◽  
Krishna Putchakayala ◽  
Philip Haigh ◽  
Lina Romero ◽  
...  
Keyword(s):  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Retrospective Chart Review ◽  
Positive Sentinel Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Recurrence ◽  
Axillary Lymph ◽  
Node Dissection

Completion axillary lymph node dissection (CLND) is presently the standard of care after a positive sentinel lymph node biopsy (SLNB). We hypothesize that the incidence of axillary recurrence in patients who do not undergo CLND for micrometastases is low, and CLND is not necessary for locoregional control. We performed a retrospective chart review of patients with invasive breast carcinoma and micrometastases detected on SLNB. The Memorial Sloan Kettering Nomogram (MSKN) predicting the likelihood of nonsentinel lymph node (NSN) metastases was compared with the incidence of positive NSN. There were 61 patients identified with a mean follow-up of 70 months. The average tumor size was 2 cm. The median number of positive SLNs was one. Twenty-eight (46%) patients had a CLND; of these, 20 patients had one positive NSN (2 of 28 [7%]) and the mean MSKN score was 12 per cent. There were 33 (54%) patients who had SLNB alone, and their mean MSKN score was 13 per cent. Axillary recurrence in this group was 1.6 per cent. We conclude the incidence of axillary recurrence in patients with micrometastases detected by SLN biopsy who do not undergo CLND is low. The use of a predictive nomogram to estimate likelihood of metastatic disease to NSN may overestimate the actual incidence of positive NSN in patients with micrometastases.

Does breast tumor location influence success of sentinel lymph node biopsy?1 1No competing interests declared.

2002 ◽  
Vol 194 (3) ◽  
pp. 278-284 ◽  
Author(s):  
Gretchen M Ahrendt ◽  
Prakash Laud ◽  
Judy Tjoe ◽  
Dan Eastwood ◽  
Alonzo P Walker ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Breast Tumor ◽  
Tumor Location ◽  
Lymph Node Biopsy ◽  
Competing Interests ◽  
Node Biopsy

scholarly journals Recent Evolution in the Management of Lymph Node Metastases in Melanoma

2021 ◽  
Vol 14 ◽  
pp. 64-71
Author(s):  
Shelby Breit ◽  
Elise Foley ◽  
Elizabeth Ablah ◽  
Hayrettin Okut ◽  
Joshua Mammen
Keyword(s):  
Lymph Node ◽  
Positive Sentinel Lymph Node ◽  
Tumor Location ◽  
Lymph Node Biopsy ◽  
Younger Age ◽  
Node Disease ◽  
Selective Lymphadenectomy ◽  
Node Metastases ◽  
National Practice ◽  
Head Neck

Introduction. Based upon two large randomized international clinical trials (German Dermatologic Cooperative Oncology Group (DeCOG-SLT) and Multicenter Selective Lymphadenectomy Trial II (MSLT-II)) which were published in 2016 and 2017, respectively, active surveillance has been demonstrated to have equivalent survival outcomes to completion lymphadenectomy (CLND) for a subset of patients who have microscopic lymph node disease. In this study, we examined the changes in national practice patterns regarding the utilization of CLND after positive sentinel lymph node biopsy (SLNB). Methods. Using the National Cancer Database, we examined CLND utilization in SLN-positive patients diagnosed with melanoma between 2012 and 2016. A hierarchal logistical regression model with hospital-level random intercepts was constructed to examine the factors associated with SLNB followed by observation vs. SLNB with CLND. Results. Of the 148,982 patients identified, 43% (n = 63,358) underwent SLNB, and 10.3% (n = 6,551) had a SLNB with microscopic disease. CLND was performed for 57% (n = 2,817) of these patients. Patients were more likely to undergo CLND if they were < 55 years of age (OR, 0.687;  p = <0.0001), ages 56 - 65 (OR, 0.886; p = 0.0237), Charlson Deyo Score = 0 (OR, 0.859; p = 0.0437), or were diagnosed with melanoma in 2012 (OR, 0.794, p = <0.0001). Conclusions. We found the utilization of CLND among patients with microscopic nodal melanoma to be significantly lower in 2016 compared to 2012. Younger age, lack of comorbidities, and primary tumor location on the trunk or head/neck were associated with higher utilization of CLND.

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

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.

Factors Associated With Disease Recurrence in Breast Cancer Patients With Negative Sentinel Lymph Node Biopsy

2016 ◽  
Vol 16 (6) ◽  
pp. e181-e186 ◽  
Author(s):  
Elena Navarro-Rodríguez ◽  
Nélida Díaz-Jiménez ◽  
Juan Ruiz-Rabelo ◽  
Irene Gómez-Luque ◽  
Guillermo Bascuñana-Estudillo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Sentinel Lymph Node Biopsy ◽  
Cancer Patients ◽  
Disease Recurrence ◽  
Lymph Node Biopsy ◽  
Breast Cancer Patients ◽  
Factors Associated ◽  
Node Biopsy

scholarly journals Prediction of Sentinel Node Status and Clinical Outcome in a Melanoma Centre

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Vera Teixeira ◽  
Ricardo Vieira ◽  
Inês Coutinho ◽  
Rita Cabral ◽  
David Serra ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Standard Procedure ◽  
Univariate Analysis ◽  
Tumor Infiltrating Lymphocytes ◽  
Lymph Node Biopsy ◽  
Breslow Thickness ◽  
Tumor Type ◽  
Infiltrating Lymphocytes

Background. Sentinel lymph node biopsy (SLNB) is a standard procedure for patients with localized cutaneous melanoma. The National Comprehensive Cancer Network (NCCN) Melanoma Panel has reinforced the status of the sentinel lymph node (SLN) as an important prognostic factor for melanoma survival. We sought to identify predictive factors associated with a positive SLNB and overall survival in our population.Methods. We performed a retrospective chart review of 221 patients who have done a successful SLNB for melanoma between 2004 and 2010 at our department. Univariate and multivariate analyses were done.Results. The SLNB was positive in 48 patients (21.7%). Univariate analysis showed that male gender, increasing Breslow thickness, tumor type, and absence of tumor-infiltrating lymphocytes were significantly associated with a positive SLNB. Multivariate analysis confirmed that Breslow thickness and the absence of tumor-infiltrating lymphocytes are independently predictive of SLN metastasis. The 5-year survival rates were 53.1% for SLN positive patients and 88.2% for SLN negative patients. Breslow thickness and the SLN status independently predict overall survival.Conclusions. The risk factors for a positive SLNB are consistent with those found in the previous literature. In addition, the SLN status is a major determinant of survival, which highlights its importance in melanoma management.

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