Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study

• Published in: Annals of surgical oncology 2017-09, Vol.24 (9), p.2728-2733
• Main Authors: Beasley, Georgia M., Hu, Yinin, Youngwirth, Linda, Scheri, Randall P., Salama, April K., Rossfeld, Kara, Gardezi, Syed, Agnese, Doreen M., Howard, J. Harrison, Tyler, Douglas S., Slingluff, Craig L., Terando, Alicia M.
• Format: Article
• Language: English
• Subjects: Biopsy; Disease Progression; Disease-Free Survival; Humans; Lymph; Lymph Node Excision; Lymph nodes; Lymphatic Metastasis; Lymphatic system; Lymphoscintigraphy; Medical prognosis; Medicine; Medicine & Public Health; Melanoma; Melanoma - diagnosis; Melanoma - secondary; Melanomas; Metastases; Neoplasm Recurrence, Local - pathology; Neoplastic Cells, Circulating; Nodes; Oncology; Population studies; Retrospective Studies; Sentinel Lymph Node - diagnostic imaging; Sentinel Lymph Node - pathology; Sentinel Lymph Node Biopsy; Skin Neoplasms - pathology; Surgery; Surgical Oncology; Survival Rate
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-017-5883-6

Background Sentinel lymph node biopsy (SLNB) is routinely performed for primary cutaneous melanomas; however, limited data exist for SLNB after locally recurrent (LR) or in-transit (IT) melanoma. Methods Data from three centers performing SLNB for LR/IT melanoma (1997 to the present) were reviewed, with the aim of assessing (1) success rate; (2) SLNB positivity; and (3) prognostic value of SLNB in this population. Results The study cohort included 107 patients. Management of the primary melanoma included prior SLNB for 56 patients (52%), of whom 10 (18%) were positive and 12 had complete lymph node dissections (CLNDs). In the present study, SLNB was performed for IT disease (48/107, 45%) or LR melanoma (59/107, 55%). A sentinel lymph node (SLN) was removed in 96% (103/107) of cases. Nodes were not removed for four patients due to lymphoscintigraphy failures (2) or nodes not found during surgery (2). SLNB was positive in 41 patients (40%, 95% confidence interval (CI) 31.5–50.5), of whom 35 (88%) had CLND, with 13 (37%) having positive nonsentinel nodes. Median time to disease progression after LR/IT metastasis was 1.4 years (95% CI 0.75–2.0) for patients with a positive SLNB, and 5.9 years (95% CI 1.7–10.2) in SLNB-negative patients ( p  = 0.18). There was a trend towards improved overall survival for patients with a negative SLNB ( p  = 0.06). Conclusion SLNB can be successful in patients with LR/IT melanoma, even if prior SLNB was performed. In this population, the rates of SLNB positivity and nonsentinel node metastases were 40% and 37%, respectively. SLNB may guide management and prognosis after LR/IT disease.