Efficacy of regional nodal ultrasound surveillance for metastatic detection in sentinel- and complete lymph node dissection-eligible melanoma patients.

e21568 Background: Nodal ultrasound (US) is the preferred method for regional surveillance of clinically node-negative (cN0) primary cutaneous melanoma (CM) when sentinel lymph node biopsy (SLNB) is not performed or unsuccessful, and for pathologically node-positive (pN+) disease without completion lymph node dissection (CLND). Methods: Retrospective review was performed of nodal US surveillance from 2011-2021 in SLNB-eligible cN0 CM patients when SLNB was deferred or technically not feasible ( i.e., from failure of lymphoscintigraphic dye migration) or those with pN+ disease on SLNB, without subsequent CLND. Patients were followed for at least 2 years or until recurrence. The primary endpoints were US detection of regional nodal recurrence and comparison to clinical exam or cross-sectional imaging (PET-CT and/or CT). Results: In total, 67 patients met inclusion criteria and underwent a median of 4 nodal US exams (interquartile range, IQR 3-5) over 2-3 years of follow-up. Thirty-two (47.8%) patients declined or had unsuccessful SLNB, and 35 (52.2%) deferred CLND in favor of nodal US surveillance. Sixteen (23.9%) patients had clinical stage IA/IB (cIA/IB) CM, 15 (22.3%) had clinical stage II (cII) disease, and 36 (53.7%) had pathologic stage III (pIII) disease. Three (4.5%) patients developed satellite/in-transit metastasis, 6 (8.9%) had regional nodal recurrence, 4 (6.0%) had both local and regional recurrence, and 7 (10.4%) developed distant metastasis. Eighteen (26.9%) patients underwent tissue sampling, with 10 positive for melanoma. Nodal recurrence was observed in patients with initial cIB (1), cIIA (1), cIIB (1), cIIC (2), pIIIA (1), and pIIIC (4) disease. Three patients (cIIA, cIIB, and pIIIC due to microsatellites) had abnormal clinical exams with concurrent palpable regional adenopathy and in-transit metastasis. One patient (pIIIC) developed local satellite metastasis followed by palpable regional adenopathy. The most common surveillance method for metastatic detection was US (6/10), followed by clinical exam (3/10) and PET-CT (1/10). All metastatic nodes on US were metabolically active on subsequent PET-CT. One patient in whom PET-CT was the initial method of detection had no confirmatory US. Conclusions: Nodal US for CM requires specific radiologic expertise and is gaining traction as a cost-effective imaging modality in the United States. Our findings support the effectiveness of nodal US surveillance in cN0 or pN+ CM patients in whom SLNB or CLND is not performed.[Table: see text]

Postoperative Radiotherapy Omitting Level Ⅳ for Locally Advanced Supraglottic and Glottic Laryngeal Carcinoma

Background: Cervical lymph nodes metastases are one of the most significant prognostic factors in patients with laryngeal carcinoma, whether treatment by surgery or by radiotherapy. The current study retrospected the postoperative radiotherapy of locally advanced supraglottic and glottic laryngeal carcinoma (at a greater risk of lymph node metastasis) to determine the effect of radiotherapy excluding cervical level Ⅳ lymph nodes. Methods: Patients of supraglottic type and glottic type were irradiated with level Ⅳ from January 2012 to June 2013, without level Ⅳ from July 2013 to December 2014, according to physicians’ decision. Ninety-three patients were selective neck irradiation (SNI) of levels Ⅱ-Ⅳ (Group A) and 87 patients were SNI of levels Ⅱ and Ⅲ (Group B). The comparison between Group A and Group B was made with observation of clinical risk of recurrence and radiation complications, as well as overall survival (OS), progress-free survival (PFS) and regional nodal recurrence-free survival. Results: No remarkable difference was observed in the distribution of recurrence, levels of relapse, OS, PFS and regional nodal recurrence-free survival between the 2 groups (p > 0.05). Mean radiation dose at level Ⅳ, thyroid and cervical esophagus showed significant difference between the 2 therapeutic groups (p < 0.01). As regard radiation complications, no significant difference was found in radiation dermatitis of any grade between the 2 groups (p > 0.05). However, there was remarkable difference in clinical hypothyroidism and radiation esophagitis between Group A and Group B (p < 0.05). Conclusions: Radiotherapy after surgery omitting level Ⅳ may improve the quality of life in patients with locally advanced supraglottic and glottic laryngeal carcinoma, won’t worsen the prognosis as well.

Invasive melanoma of the face: Patterns of local and regional disease in 261 patients managed at a single institution

e20015 Background: The face is a common site of melanoma occurrence, and lesions in this location present specific management challenges. The purpose of this study was to examine outcomes associated with invasive melanoma of the face, with respect to local, regional and distant recurrence. Methods: Patients with invasive melanoma of the face managed from 1997–2008 were identified from a large population-based tumor registry and retrospectively reviewed. Details of lesion histopathology, initial management, sentinel node biopsy (SNB), and local, regional or distant recurrences were recorded. Results: 261 patients were reviewed, mean age 68 and median tumor thickness 0.87mm. Three patients (1.1%) had clinically involved nodes at presentation and underwent nodal dissection. Of 108 patients who were eligible for SNB (with tumor thickness >1mm, Clark level ≥IV or ulceration) this was performed in only 29 (27%). SNB was successfully identified in 28 (97%). No facial nerve injuries occurred. A mean of 1.5 nodes were removed; from parotid region in 24, cervical chain in 12, submandibular in 5, submental in 1 and retroauricular in 1. SNB was positive in 3 (11%) who subsequently underwent neck dissection/parotidectomy. Mean follow-up duration was 37 months. Local recurrence occurred in 13 (5%), in-transit recurrence in 4 (1.5%) and distant recurrence in 20 (7.7%). Regional nodal recurrence occurred in 10 (3.8%); after negative SNB in 1 (SNB failure rate 3.7%), after unsuccessful SNB in 1, following neck dissection for nodal disease at presentation in 1, and in 7 who did not undergo SNB (including 6 patients who were eligible). During the study period there were 60 deaths (crude mortality 23%); due to melanoma in 16, unrelated causes in 41, and indeterminate in 3. Conclusions: Facial melanoma is associated with low rates of regional recurrence despite a low rate of SNB for eligible lesions. Sentinel nodes were most commonly found in the parotid region and could be safely removed without nerve injury. Most regional recurrences occurred in patients eligible for SNB not undergoing this procedure. Due to the older age of patients with facial melanoma, most deaths occurring are from unrelated conditions, and distant metastatic disease was seen in only a small percentage of cases. No significant financial relationships to disclose.