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01-09-2015 | Melanomas

Detailed Pathological Examination of Completion Node Dissection Specimens and Outcome in Melanoma Patients with Minimal (<0.1 mm) Sentinel Lymph Node Metastases

Authors: Lodewijka H. J. Holtkamp, MD, Shu Wang, MBBS, James S. Wilmott, PhD, Jason Madore, MSc, Ricardo Vilain, MBBS, PhD, FRCPA, John F. Thompson, MD, FRACS, FACS, Omgo E. Nieweg, MD, PhD, Richard A. Scolyer, MD, FRCPA, FRCPath

Published in: Annals of Surgical Oncology | Issue 9/2015

Abstract

Background

Nonsentinel lymph nodes (NSLNs) are rarely involved in patients with minimal volume melanoma metastases in sentinel lymph nodes (SLNs). Therefore, it has been suggested that completion lymph node dissection (CLND) is not required. However, the lack of routine immunohistochemical staining and multiple sectioning may have led to failure to identify additional positive nodes. The present study sought to more reliably determine the tumor status of NSLNs in patients with minimally involved SLNs and their clinical outcome.

Methods

A total of 21 tumor-negative CLND specimens from 20 patients with SLN metastases of <0.1 mm in diameter treated between 1991 and 2013 were examined with a more detailed pathologic protocol (five new sections stained with/for H&E, S-100, HMB45, Melan-A, and H&E). Clinical follow-up data were also obtained.

Results

Of the 343 examined NSLNs, 1 was found to harbor a 0.18-mm subcapsular sinus metastasis. No metastases were identified in the other NSLNs. Median follow-up was 48 months (range 17–130 months). Six patients (30 %) developed a recurrence. At the end of follow-up, 15 patients (75 %) were alive without sign of melanoma recurrence and 5 patients (25 %) had died of melanoma. Estimated 5-year melanoma-specific survival was 64 %. The patient with the additional positive NSLN remains without recurrence after 130 months follow-up.

Conclusions

Although the risk of additional nodal involvement is low, detailed pathologic examination may identify NSLN metastases not identified using routine protocols. Therefore, nodal clearance appears to be the safest option for these patients, pending the results of prospective trials.

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Title: Detailed Pathological Examination of Completion Node Dissection Specimens and Outcome in Melanoma Patients with Minimal (<0.1 mm) Sentinel Lymph Node Metastases
Authors: Lodewijka H. J. Holtkamp, MD
Shu Wang, MBBS
James S. Wilmott, PhD
Jason Madore, MSc
Ricardo Vilain, MBBS, PhD, FRCPA
John F. Thompson, MD, FRACS, FACS
Omgo E. Nieweg, MD, PhD
Richard A. Scolyer, MD, FRCPA, FRCPath
Publication date: 01-09-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 9/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4615-z

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Detailed Pathological Examination of Completion Node Dissection Specimens and Outcome in Melanoma Patients with Minimal (<0.1 mm) Sentinel Lymph Node Metastases

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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