Diagnostic excision of the Rosenmüller's node.Screening for occult metastases before elective regional lymph node dissection in patients with lower limb melanoma?

Abstract

Elective radical groin dissection was performed on 297 consecutive patients with high-risk melanoma of the leg, Anderson Stages I, IIA, IIIA. By separate histologic examination of the so-called "Rosenmüller's node," the other inguinal, and the external iliac lymph nodes, the diagnostic excision of the Rosenmüller's node was tested as a suitable mode of screening for metastases before a planned elective regional lymph node dissection. Eighty patients (27%) presented with what was histologically determined to be occult groin metastases. Rosenmüller's node was involved in 30 of these cases; in the remaining 50, however, it was not affected; that is, 63% of the cases were false-negative. Thus, the involvement of Rosenmüller's node is not representative of metastases in the other ilioinguinal lymph nodes, but is rather a matter of chance. In women with superficial spreading melanoma the rate of occult lymph node metastases was significantly lower than that in men with melanomas of the other type. Iliac lymph node involvement was observed in 18 patients (22%) depending on clinical stage and depth of invasion of the primary tumor.

Prognosis and surgical management of patients with palpable inguinal lymph node metastases from melanoma

“…In this study CT was able to detect more extensive pelvic nodal disease, but the overall sensitivity was poor. Peroperative frozen-section analysis of the lymph nodes of the femoral canal has been assessed as a marker of pelvic nodal involvement with mixed results 4,16,36 . As with CT the results show a low sensitivity.…”

Pelvic lymph node status prediction in melanoma patients with inguinal lymph node metastasis

“…Previous studies report NPVs of 94-97% in the case of micrometastasis [34,35] and of 80-95% in the case of macrometastasis [36][37][38]. Interestingly, if SLNB-positive patients with negative Cloquet's LN had avoided pelvic dissection, the reduction rate would have been up to 84%, with an error rate of 3.8%.…”

Routine biopsy of cloquet's node is of limited value in sentinel node positive melanoma patients

“…Previous studies have addressed the association of CN status and pelvic disease 5, 14, 15, 18–20. A summary of the sensitivity, specificity, and predictive values of CN in detection of pelvic metastases as determined in these studies is provided in Table IV.…”

“…In all but one 15, the analyses were derived from patients who underwent therapeutic lymph node dissection for clinical evidence of nodal disease prior to the widespread adoption of SNB. Even in these populations, which represent patients with more advanced regional disease than those staged using SNB, the varied results have led some authors to conclude that CN serves as an accurate determinant of pelvic disease status 14, 18, and others to emphasize its unreliability 19, 20.…”

“…Following sequential anatomic lymphatic drainage patterns that also serve as the foundation of SNB, melanoma involvement of CN has been considered to be potentially reflective of the disease status of pelvic nodes, as well as an indication for pelvic dissection 17, 18. Prior to the adoption of SNB, rates of metastasis to CN as found during elective lymphadenectomy for clinical evidence of nodal disease ranged from 24% to 49% 14, 18–20. However, in the setting of SNB, few, if any, studies have evaluated the frequency of CN metastases and the usefulness of CN in prediction of pelvic disease during completion lymph node dissection.…”