Sentinel lymph-node biopsy after previous wide local excision for melanoma (original) (raw)
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Melanoma Research, 2008
The aim of this study was to determine whether excision biopsy and primary closure of primary cutaneous melanoma modifies lymphatic drainage and accuracy of sentinel node biopsy. Thirty patients with 31 cutaneous melanomas were prospectively enrolled to undergo lymphoscintigraphy (LS) before and after excision biopsy. 99m Tc-human serum albumin nanocolloid was first injected intradermally around the primary tumor and subsequently, after excision biopsy, adjacent to the scar. Sentinel nodes were identified by preoperative LS and the c-probe. Patent Blue V dye was injected intraoperatively before sentinel node biopsy. Intraoperative sentinel node identification was 100%. In 23 of 31 cases, both LSs were concordant in terms of nodal basins visualized. Two patients had a basin downstaged and six patients had a basin upstaged by the second LS. Only 50% of LS hot nodes stained blue (42 of 84). In 24 of 31 cases, the sentinel node was negative for metastases. Seven patients underwent complete lymph node dissection because of sentinel node positivity. Only one patient had metastases also to a non-sentinel node. After a median follow-up of 30 months lymph node metastases have not been observed in the eight discordant cases. This study shows that sentinel node identification and biopsy after lymphatic mapping is accurate after excision biopsy of primary cutaneous melanoma. Excision biopsy may, however, modify lymphatic drainage and a narrow excision margin should be performed if melanoma is suspected.
[Sentinel lymph node biopsy in melanoma patients: methods, indications, and clinical significance]
Medicina, 2003
The incidence of melanoma in Lithuania has doubled over the last decade. Sentinel lymph node biopsy, currently becoming a standard method in the US and Europe, is a minimal invasive and highly sensitive surgical procedure. It can be used for the detection of melanoma micrometastasis in regional lymph nodes in cases when non-invasive methods fail to reveal them. Both disease-free survival and disease-specific survival were significantly better for patients with a negative sentinel lymph node biopsy. A. Breslow thickness, W. H. Clark level, and ulceration of the melanoma were strong predictors, but not as strong as the histological status of the sentinel lymph node. The procedure for sentinel lymph node biopsy is nowadays standardized, including preoperative dynamic lymphoscintigraphy combined with intraoperative gamma probe guidance and blue-dye injection. The aim of this article is to present an update of the sentinel lymph node biopsy method and the prognostic significance of this procedure on the basis of more than 400 sentinel lymph node biopsy's carried out at the Department of Dermatology of the Otto-von-Guericke University, Magdeburg since 1997 and the results of recently published studies in the literature.
Sentinel lymph node biopsy in melanoma patients: the medical oncologist's perspective
Journal of Surgical Oncology, 2004
Introduction: Sentinel lymph node biopsy is the standard procedure for lymph node staging in intermediate thickness melanoma. In Iran, this procedure has not been addressed sufficiently. In this study, we report our experience in this area. Methods: Ten consecutive patients with intermediate thickness melanoma where included in our study. 1.5 mCi of Tc-99m antimony sulfide colloid in two divided dose was injected around the tumor. All patients underwent surgery 2-4 hours after injection of the tracer. Patent blue V dye was also used for 8 patients. Using a hand-held gamma probe, the sentinel nodes were harvested and sent to the pathologist for frozen section and H&E review. For patients with positive sentinel nodes, lymph node dissection was performed. Results: At least one sentinel node could be harvested in all patients. The mean number of sentinel nodes was 1.66. Detection rate with radiotracer and blue dye was 100% and 75% respectively. 30% of the patients had positive sentinel nodes. One patient in the pediatric age range and one head and neck melanoma were included in our study with successful sentinel node mapping. Conclusion: Sentinel lymph node biopsy using Tc-99m antimony sulfide colloid is a reliable and safe method in melanoma patients which can help in treatment planning and patient's ultimate prognosis.
Sentinel Lymph Node Biopsy in Cutaneous Melanoma, a Clinical Point of View
Medicina
Sentinel lymph node biopsy (SLNB) is a surgical procedure that has been used in patients with cutaneous melanoma for nearly 30 years. It is used for both staging and regional disease control with minimum morbidity, as proven by numerous worldwide prospective studies. It has been incorporated in the recommendations of national and professional guidelines. In this article, we provide a summary of the general information on SLNB in the clinical guidelines for the management of cutaneous malignant melanoma (American Association of Dermatology, European Society of Medical Oncology, National Comprehensive Cancer Network, and Cancer Council Australia) and review the most relevant literature to provide an update on the existing recommendations for SLNB.
Annals of surgical oncology, 2017
To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is re...
Sentinel lymph node biopsy for melanoma: indications and rationale
Cancer control : journal of the Moffitt Cancer Center, 2009
The disease status of regional lymph nodes is the most important prognostic indicator for patients with melanoma. Sentinel lymph node biopsy (SLNB) was developed as a technique to surgically assess the regional lymph nodes and spare node-negative patients unnecessary and potentially morbid complete lymphadenectomies. We reviewed the literature on SLNB for cutaneous melanoma to provide insight into the rationale for the current widespread use of SLNB. Multiple studies show that the status of the SLN is an important prognostic indicator. Those with positive SLNs have significantly decreased disease-free and melanoma-specific survival compared with those who have negative SLNs. In the Multicenter Selective Lymphadenectomy Trial I (MSLT-I), in which patients with intermediate-thickness melanoma were randomized to SLNB (and immediate completion lymphadenectomy if the SLN was positive) vs observation (and a lymphadenectomy only after presenting with clinically evident recurrence), the 5-y...
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2006
UNLABELLED An observational multicentric Italian trial on sentinel node biopsy (SNB) in melanoma patients was performed to diffuse a common SNB protocol nationwide (Italy). We report herein the results of this trial. The influence of some technical aspects on the outcome of SNB was also investigated, because a certain degree of variability was accepted in performing lymphoscintigraphy. METHODS From January 2000 to December 2002, 1,313 consecutive patients with primary cutaneous melanoma (Breslow thickness, >1.0 mm or <1.0 mm but with ulceration, Clark level IV-V, presence of regression) were enrolled by 23 centers. One half to 1 mL of 99mTc-labeled human albumin colloid, at a suggested dosage of 5-15 or 30-70 MBq, was injected intradermally, closely around the scar, the same day or the day before SNB. Intraoperatively, Patent blue was associated when a definitive wide excision of the primary was required. A positive sentinel node (SN) was defined when containing melanoma cells...