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

Düker, I.; Starz, Hans; Bachter, D.; Balda, Bernd‐Rüdiger

doi:10.1159/000051641

Cited by 35 publications

(25 citation statements)

References 20 publications

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“…20,28 We have previously shown that that maximum tumor diameter, measured by an ocular micrometer is an acceptable surrogate for tumor area in evaluating tumor burden in lymph nodes. 11,29 The approach of using micrometric assessment of metastatic tumor diameter has been profitably developed by Starz et al, 30,31 in Augsburg, and alone or in combination with determination of the number of 1-mm-thick slices of the sentinel nodes that contain tumor applied to the evaluation of sentinel nodes. The use of ocular micrometers to evaluate the diameter of metastases in sentinel node has also been reported by Wagner et al, 32 and Ranieri et al 33 We are currently collaborating with the Augsburg group to compare the predictive value of area measurements of nodal tumor with the information obtainable by evaluation of the micrometer-measured maximum diameter nodal tumor.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that similar approaches are also applicable to evaluation of the sentinel node in breast cancer 18,34 and Merkel cell carcinoma 31 and it will be important to assess whether similar approaches can be successfully applied to sentinel node removed from patients with other kinds of cancer. The evaluations required to go some distance beyond routine pathological assessment, but if it is shown that there is value for patient evaluation and management, pathologist will undoubtedly incorporate these new tasks in the range of their activities.…”

Section: Discussionmentioning

confidence: 99%

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Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

et al. 2004

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Lymphatic mapping and sentinel node biopsy are well-established techniques for staging and managing patients with melanoma, breast cancer and other malignancies that spread initially to the regional lymph nodes. Identification of tumor in the sentinel node is the most precise staging technique currently available. The sentinel node is the site of metastatic melanoma in approximately 20% of melanoma patients and if tumor is present in the sentinel node it is customary to perform a complete dissection of the lymph nodes of the affected nodal basin. This may be overtreatment for some patients as tumor is identified in the nonsentinel nodes of only one-third of sentinel node-positive melanoma patients treated by completion lymphadenectomy. If it were possible accurately to identify the minority of patients with tumor in the nonsentinel nodes, the patients most likely to benefit from lymphadenectomy, the remaining patients could be spared a potentially morbid operation that is unlikely to confer clinical advantage. In 90 patients with a melanoma-positive sentinel node, who subsequently had a completion lymphadenectomy, we evaluated and compared the capacity of characteristics of the primary melanoma and of the sentinel node to predict individuals likely to have tumor in nonsentinel nodes. We assessed the Breslow thickness of the primary, the amount of tumor in the sentinel node (relative tumor area) and, as an index of immune modulation of the sentinel node, the density of dendritic leukocytes in the nodal paracortex. The relative area of tumor in the sentinel node and Breslow thickness of the primary melanoma most accurately predicted the presence of tumor in the nonsentinel nodes (P ¼ 0.0001 in both cases-Wilcoxon rank sums). The presence of melanoma in the nonsentinel nodes was also predicted by the density of dendritic leukocytes in the paracortex (P ¼ 0.008-Wilcoxon rank sums). These three observations assessed alone and in combination predict the presence of tumor in the nonsentinel nodes with high accuracy. The same characteristics also significantly correlated with tumor recurrence (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0.0007) and death from melanoma (tumor burden, P ¼ 0.0001, Breslow, P ¼ 0.0001 and dendritic cell density, P ¼ 0. Keywords: melanoma; sentinel node; tumor burden; immune suppression; tumor recurrence; melanoma deathThe techniques of lymphatic mapping and sentinel node biopsy were developed to improve the management of patients with high-risk (thick and deep) primary melanoma with a high potential for metastases, but no clinical evidence of metastatic spread.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

et al. 2004

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“…Avec le développement de la lymphoscintigraphie et du repérage peropératoire du ganglion sentinelle, la procédure du ganglion sentinelle a été proposée dans le CCM depuis quelques années dans le but d'identifier précocement la présence de micrométastases ganglionnaires. Trente pour cent des patients initialement considérés au stade I ou II sont ainsi reclassés en stade III [17][18][19][20][21]. La présence de micrométastases lymphatiques dans le ganglion sentinelle est un facteur de mauvais pronostic avec environ 60 % de rechute à trois ans contre 20 % seulement en l'absence de micrométastases [20].…”

Section: Stadification Et Pronosticunclassified

Carcinome à cellules de Merkel : prise en charge actuelle

Girard

Guillot

2010

Annales de Dermatologie et de Vénéréologie

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“…Many authors recommend an elective regional lymphadenectomy at the time of primary tumor excision (for an overview, see Lawenda et al [11]). A less invasive strategy, the sentinel lymph node biopsy technique, is currently being evaluated [12, 13, 14]. …”

Section: Therapy Of MCCmentioning

confidence: 99%

Successful Targeted Radiotherapy with <sup>90</sup>Y-DOTATOC in a Patient with Merkel Cell Carcinoma

Meier¹,

Waldherr

Herrmann³

et al. 2004

Oncology

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Merkel cell carcinomas (MCC) belong to the family of neuroendocrine tumors. In addition to other markers, they express somatostatin receptors. They are uncommon, highly malignant skin tumors with an aggressive clinical course. They develop in sun-exposed areas of the skin, mostly in elderly patients. In addition to frequent locoregional recurrences, there is a high incidence of distant metastases. Treatment is stage dependent and consists of operation and chemo- and/or radiotherapy, respectively. The advanced age of patients often impedes adequate therapy. ⁹⁰Y-DOTATOC is a novel radiolabeled somatostatin analogue containing the active octapeptide of somatostatin. It is very well tolerated and offers the option of treating somatostatin receptor-positive tumors by targeted radiotherapy. We report the case of an 83-year-old woman with recurrent MCC of the left cheek. The primary tumor and several relapses were treated with surgery and locoregional radiotherapy. After the 3rd relapse, she was treated 4 times with ⁹⁰Y-DOTATOC and two complete remissions were achieved. The fourth administration after the 2nd relapse was ineffective and conventional chemotherapy was started. There were no side effects of the ⁹⁰Y-DOTATOC. We conclude that due to its good tolerability, ⁹⁰Y-DOTATOC therapy should be evaluated further as a new therapy for somatostatin receptor-positive MCC.

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

Cited by 35 publications

References 20 publications

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node

Carcinome à cellules de Merkel : prise en charge actuelle

Successful Targeted Radiotherapy with <sup>90</sup>Y-DOTATOC in a Patient with Merkel Cell Carcinoma

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