Pelvic sentinel lymph nodes have minimal impact on survival in melanoma patients

Abstract

Background Lower limb or trunk melanoma often presents with femoral and pelvic sentinel lymph nodes (SLNs). The benefits of harvesting pelvic lymph nodes remain controversial. In this retrospective study, the frequency and predictors of pelvic SLNs (PSLNs), and the impact of PSLNs on survival and staging was investigated. Methods Altogether 285 patients with cutaneous melanoma located in the lower limb or trunk underwent sentinel lymph node biopsy of the inguinal/iliac lymph node basin at Helsinki University Hospital from 2009–2013. Patient characteristics, detailed pathology reports and follow-up data were retrieved from hospital files. Subgroups of patients categorized by presence of PSLNs were compared for outcome parameters including progression-free survival, melanoma-specific survival and groin recurrence. Results Superficial femoral/inguinal SLNs were present in all patients and 199 (69.8 per cent) also had PSLNs removed. Median number of SLNs per patient was five and median number of PSLNs was two. Sixty-three patients (22.1 per cent) had metastases in their SLNs and seven (2.5 per cent) had metastases in PSLNs. A single patient had metastases solely in PSLNs, while superficial SLNs remained negative. Harvesting PSLNs or the number of PSLNs retrieved had no impact on progression-free survival or overall survival. The removal of PSLNs did not affect the risk of postoperative seroma or lymphoedema. The only predictor of positive PSLNs was radioactivity count equal to or more than that of the hottest superficial SLNs. Conclusion Pelvic SLNs have minimal clinical impact on the outcome of melanoma patients especially in cases with negative superficial femoral/inguinal SLNs. Removal of PSLNs should be considered when they are the most radioactive nodes or equal to the hottest superficial femoral/inguinal SLNs in lymphoscintigraphy or during surgery. Preliminary results were presented in part at the International Sentinel Node Society Biennial Meeting, Tokyo, Japan, 11–13 October 2018.

A role for pelvic sentinel lymph nodes in lower extremity melanoma?

“…However, Schuitevoerder et al 9 recommended PSLNs to be biopsied when SSLNs are positive, or drainage goes straight to the PSLNs. Vuoristo et al 11 proposed removal of PSLNs if they are more or equally radioactive to the most radioactive SSLN. It is important to note when not examining the PSLNs, the first-tier SLN determines whether the patient needs adjuvant therapies.…”

“…Other predictive factors have been found to be older age, greater Breslow thickness, and melanoma subtype. 8–11 Regarding the melanoma positivity of PSLNs, it is associated with male sex, tumor thickness, melanoma subtype, location in feet, and higher radioactivity count of the node. 9,11 However, 30.8% of patients with PSLN had positive SSLN in SLNB, when patients without PSLN, the rate was 17.5%.…”

“…8 Studies that have also taken truncal melanomas into account have found percentages of between 8% and 69.8%. 9–12…”

“…It has been suggested that PSLNs should be retrieved if there is an isolated PSLN without SSLN, or they are the more or equally radioactive to the SSLNs. 9,11,14…”

“…PSLNs have been shown to have very little impact on staging, which speak against their routine retrieval. 10,11 The main aim of our study was to determine whether there is any effect on recurrence or survival when drainage to PSLNs is identified, but they are not removed.…”