Surgical management of tumor-positive interval node in melanoma patients

Abstract

The presence of interval nodes (IN) in melanoma is testified in several studies and sometimes these lymph nodes can contain metastatic disease. Currently there are no guidelines about the management of patients with tumor-positive INs.We enrolled all patients affected by melanoma who underwent sentinel lymph node biopsy (SLNB) in a single institution. All patients with tumor-positive IN underwent the lymphadenectomy of the subsequent draining lymphatic field. Prognosis of IN+-patients was compared with subjects with positive SLNB in usual field through Kaplan-Meier and multivariate Cox regression analysis.Overall 596 subjects underwent lymphoscintigraphy and one or more INs were identified in 94 (15.8%) patients. The mean number of sentinel lymph nodes (SNs) identified per patient was significantly higher in patients with INs. Macrometastasis were more common in patients with INs. Matched pair analysis testified a statistically significant better prognosis in patients with positive-INs when compared with patients with positive SNs in usual side with the same demographic and clinical characteristics. These findings were confirmed both in analysis of 10-year recurrence-free period, then in 10-years overall survival analysis.Lymphadenectomy of the lymphatic draining field beyond positive-IN testify has proved to be a safe procedure that may improve prognosis in melanoma patients with tumor-positive INs. The better prognosis of patients with tumor-positive INs undergoing lymphadenectomy may be justified by the earlier treatment of lymphatic metastases. Further multicentric comparative studies are needed to evaluate possible impact of this procedure on prognosis of melanoma patients.

Prevention of Secondary Lymphedema after Complete Lymph Node Dissection in Melanoma Patients: The Role of Preventive Multiple Lymphatic–Venous Anastomosis in Observational Era

“…All patients underwent lymphoscintigraphy; technetium-nanocolloid human serum albumin was injected close to the primary lesion. The reduction in artefacts was ensured by the use of ultra-highresolution collimators [14,15]. Dual-headed digital gamma cameras were used to acquire dynamic and static images after the radiolabeled colloid injection, and then after every node was visualized [16].…”

<p>Studies on the treatment of melanoma with folate acid conjugated dextran and lauryl alcohol loaded with IMD0354</p>

“…It is well established that malignant melanoma (MM) is initiated by mutations in epidermal melanocytes that cause de-regulation of the cell cycle. MM accounts for 65% of skin cancer mortalities and is one of the deadliest of all solid tumors 1–4. Currently, molecular targeted therapy is another option for cancer treatment, but it is distinct from the mechanism of traditional antitumor drug therapy, in that it can block cancer cell division and suppress its replication, thus restraining its killing effect 5,6.…”

Current management of regional lymph nodes in patients with melanoma

“…In our Department we perform multiple lymphatic-venous anastomoses for preventive purposes, and we also perform lymph node transfer for therapeutic purposes. [5][6][7] We believe that the prevention and treatment of lymphedema should be assessed within the procedural risks of SLN and CLND.From July 1994 to December 2012 in the clinical practice of the Department of Plastic Surgery of the University of Bari, we analyzed 680 patients suffering from melanoma, focusing our study on head-neck melanoma patients (HNM). 8 The disease-free period is significantly shorter in HNM patients compared with those affected with melanoma in other areas like the limbs and the torso, probably due to early lymphatic involvement.…”

“…In our Department we perform multiple lymphatic-venous anastomoses for preventive purposes, and we also perform lymph node transfer for therapeutic purposes. [5][6][7] We believe that the prevention and treatment of lymphedema should be assessed within the procedural risks of SLN and CLND.…”