Sentinel lymph node biopsy in acral melanoma: A Korean single‐center experience with 107 patients (2006–2018)

Abstract

Background: Sentinel lymph node biopsy (SLNB) of primary cutaneous melanoma as an important staging method has not been popularly undertaken in Korea and only a few studies with small patient numbers have been published. Aim: We examined the clinical feasibility and overall outcomes of SLNB in acral melanoma (AM) of Korean in Kyungpook National University Hospital (KNUH) over the past 13 years. Methods: SLNB in AM patients during 2006–2018 were analyzed retrospectively for sentinel lymph node (SLN) harvesting rate, positivity rate, positivity‐relevant overall survival (OS) and disease‐free survival (DFS), and its side effects. Results: A total of 109 AM patients who underwent SLNB were enrolled. Harvested nodes were identified from 107 patients and SLN harvesting rate was 98.2%. The mean Breslow thickness (±standard deviation) was 3.38 ± 3.03 mm, and the proportion of ulcerated melanomas was 64%. Twenty‐two (20.6%) had a tumor‐positive SLN and, among them, 82% (18/22) underwent immediate complete lymph node dissection (CLND). The metastasis‐positive nodal basin after CLND was detected in 16.7% of cases (3/18). Tumor‐negative SLN cohorts showed significantly better OS and DFS than tumor‐positive ones (P = 0.006 and P < 0.001 for each). Two side effects, one seroma and one lymphocele, were observed without major sequelae. Conclusion: SLNB, crucial management of melanoma, proved its efficacy to predict patients’ prognosis and could be performed successfully and safely in Korean AM patients by interdisciplinary cooperation between dermatology and other surgical departments. SLN(−) showed significantly better OS and DFS than SLN(+). Significant risk factors for DFS were Breslow thickness, the presence of ulceration and the presence of SLN metastasis. SLNB should be encouraged in order to stage melanoma accurately and direct the proper management in Korean AM.

Survival benefit of sentinel lymph node biopsy in Asian melanoma patients

“…Among the 161 patients who underwent SLNB in our study, 33 patients (20.5%) had positive sentinel lymph node(s), and the average melanoma thickness of the SLNB group was 3.49 mm. The proportion was close to the result of a study focusing on ALM in Korea, in which the average melanoma thickness was 3.38 mm and the sentinel node positivity rate was 20.6% (Sohng et al, 2021). Compared to the MSLT‐I trial, in which the average melanoma thickness in the SLNB group was 1.98 mm, the positive rate of sentinel nodes was 15.9% (Morton et al, 2006).…”

Prognostic value of the number of biopsied sentinel lymph nodes for Chinese patients with melanoma: A single-center retrospective study

“…Whereas, the distribution of melanoma subtypes in Asian people was reported to be significantly different from that in Western population. Although acral melanoma was rarely (1-9%) reported in Caucasians [19,20], it represents the most common subtype of melanoma in Asian population (50-70.9%) [21][22][23]. In the present study, this proportion reached 69.8%.…”

Factors influencing locoregional recurrence and distant metastasis in Asian patients with cutaneous melanoma after surgery: A retrospective analysis in a tertiary hospital in Taiwan

“…Previous studies described male sex, ulceration of the primary tumor, large or thick primary tumor, advanced pathological stage, and positive sentinel lymph node as independent prognostic factors of ALM. 29,30 Sohng et al 31 reported Breslow thickness, tumor ulceration, and SLN metastasis as the risk factors for disease-free survival in Korean with 107 ALM patients. Another Asian study also revealed that ALM and non-ALM had no significant prognostic difference.…”