Primary therapy of malignant melanomas: sentinel lymphadenectomy

“…Internationally established standards have recently been published for cutaneous malignancies [13]. At least for melanoma they guarantee that the histological status of the SLN is highly representative of the whole lymph node basin [11, 12, 16, 17, 25]. This enables precise staging of patients without the morbidity of ELND.…”

Section: Discussionmentioning

confidence: 99%

“…The details of the method used by us have been published elsewere [11, 12, 13, 14, 15, 16, 21, 22]. In short: the first step preoperatively was to perform lymphoscintigraphy using technetium 99 ( 99 Tc), sulfur or human albumin.…”

Section: Methodsmentioning

confidence: 99%

“…Since MCC usually affects the elderly, most dermatosurgeons do not advocate elective lymph node dissection (ELND) due to its high rate of complications. The low-morbidity intervention of sentinel lymphonodectomy (SLNE) proved its efficiency in melanoma [11, 12, 13, 14, 15, 16, 17]to reliably identify those patients who can be spared radical lymph node dissection. The further metastatic risk of the other patients highly depends on the S stage (see below) of the sentinel lymph node (SLN).…”

Section: Introductionmentioning

confidence: 99%

“…Based on our experiences with malignant melanoma [11, 12, 13, 15, 16, 17], we attempted to identify in this study which MCC patients would benefit from further regional surgery using the technique of SLNE. The procedure is based on the identification of the first lymph node draining the primary tumor site, the so-called SLN, by preoperative and intraoperative mapping of lymphatic channels.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic and Therapeutic Implications of Sentinel Lymphonodectomy and S-Staging in Merkel Cell Carcinoma

et al. 2001

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Background: Merkel cell carcinoma (MCC) is a rare but very aggressive neuroendocrine neoplasm of the skin with a high propensity for early lymph node metastasis and subsequent distant spread. Optimal treatment and prognostic factors are poorly defined. Objective: The purpose of this study is to assess the prognostic and therapeutic relevance of sentinel lymphonodectomy in MCC. Methods: Five patients with biopsy-proven MCC underwent gamma-probe-guided sentinel lymphonodectomy assisted by lymphatic mapping. From each sentinel lymph node (SLN), a series of paraffin sections was histologically and immunohistochemically examined for the presence of micrometastases, which were then staged according to the recently published S classification. Results: Four of the 5 patients showed metastatic disease in the SLNs, 3 of which were classified as S₂, 1 as S₃. Only 1 of the S₂ patients demonstrated additional positive nodes at completion lymphonodectomy. The patient staged as S₃ refused a radical lymph node dissection and died within 1 year due to widespread metastasis. Conclusions: Sentinel lymphonodectomy is a low-morbidity procedure which enables an early detection and exact staging of regional lymph node metastases with potentially high prognostic and therapeutic relevance in MCC.

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A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma

Starz

Balda

Krämer

et al. 2001

Cancer

266

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BACKGROUND The sentinel lymph nodes (SLNs) as the primary targets for lymphatic metastases can be removed selectively by γ probe‐guided sentinel lymph nodectomy (SLNE) in nearly all patients with cutaneous melanoma. Correspondingly high standards in terms of specificity, sensitivity, and microstaging are required for the evaluation of SLNs. METHODS Since 1995, the authors have performed SLNE in 389 lymph node regions (LNRs) on 342 patients with melanoma. The harvested 636 SLNs and a further 1394 nonsentinel lymph nodes (non‐SLNs) were evaluated by standardized, semiserial section histology, including immunohistochemistry. For each LNR, this technique permitted routine S classification using two simple morphometric parameters: the number of tumor‐involved, 1‐mm slices of the SLNs (n) and the centripetal depth of metastatic cell invasion (d). S1 was defined by 1 ≤ n ≤ 2 and d ≤ 1 mm, equivalent to localized peripheral tumor cell deposits; S2 was defined by n > 2 and d ≤ 1 mm, indicating more extended peripheral metastases; S3 was defined by d > 1 mm in SNLs with deeper metastatic infiltration; and S0 meant no detectable tumor cells (n = 0). RESULTS The authors diagnosed 325 SLNs as S0, 24 SLNs as S1, 22 SLNs as S2, and 18 SLNs as S3. The occurrence of at least one melanoma‐positive non‐SLN subsequent regional completion lymph node dissection (RCLND) significantly increased from 0 of 12 in S1 SLNs to 2 of 13 in S2 SLNs and 9 of 15 in S3 SLNs (P = 0.001; chi‐square test). Like the T classification of the primary melanoma, the S classification proved to be a highly significant predictor for distant metastasis (P < 0.001). It turned out to be an independent factor of influence on distant metastasis and survival in multivariate Cox analyses, which included tumor thickness, primary tumor site, patient gender, and patient age as covariates. CONCLUSIONS The data presented recommend the S‐staging concept as a promising option to fill a gap between the T and conventional N component of the pTNM classification. If its predictive capacity can be confirmed in multicenter studies, then the S classification may become the decisive criterion for or against RCLND, and a combined T plus S staging system will help to improve prognostically relevant stratification of melanoma patients in adjuvant therapy trials. Cancer 2001;91:2110–20. © 2001 American Cancer Society.

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Primary therapy of malignant melanomas: sentinel lymphadenectomy

Abstract: gamma-Probe-guided SLNE is a reliable procedure with minimal complications that should be performed in all pT3 + 4 (intraoperative frozen section histology) melanomas without clinically evident metastases.

Cited by 39 publications

References 12 publications

Tyrosinase RT-PCR as a Supplement to Histology for Detecting Melanoma and Nevus Cells in Paraffin Sections of Sentinel Lymph Nodes

Tyrosinase RT-PCR as a Supplement to Histology for Detecting Melanoma and Nevus Cells in Paraffin Sections of Sentinel Lymph Nodes

Prognostic and Therapeutic Implications of Sentinel Lymphonodectomy and S-Staging in Merkel Cell Carcinoma

A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma

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