medigraphic.com
ISSN 0210-5187 (Electronic)

2017, Number 3

<< Back Next >>

Med Cutan Iber Lat Am 2017; 45 (3)

Biologic behavior and value of sentinel lymph node biopsy in thick melanoma (prognostic factors of T4 melanoma)

Campos-Arbulú AL, Agostina-Mattioni L, Florencia-Reino R, Fernández-Vila JM, Arístides-Mezzadri N

Language: Spanish
References: 19
Page: 195-199
PDF size: 280.03 Kb.


ABSTRACT

Introduction: Sentinel node’s value in thick melanoma is controversial because of frequent metastasis. Our aim is to analyze the biological behavior and the usefulness of sentinel lymph node biopsy in thick melanoma. Material and methods: Patients treated for T4 melanoma were analyzed. The variables considered were demographic, clinical, surgical, pathological and follow up. Results: Forty patients included, 67% male, mean age 68.6 years old. Twenty-eight were ulcerated melanomas (70%). Median Breslow thickness was 6 mm (4.1-55). Seven showed macroscopic lymph node metastasis and lymphadenectomy was performed. In 9/24 patients the sentinel lymph node was positive and lymphadenectomy followed. In 3 patients an additional positive node was identified. Nodular histology was associated with positive sentinel node (p = 0.041). Specific mortality was 35% with 56 months of mean follow up (4-174). Five year overall, specific and disease free survival were 56.5%, 60% and 43%. When comparing positive versus negative sentinel node, five year overall survival was 55% and 63% (p = 0.36), specific survival 55% and 75% (p = 0.197) and disease free survival 32.5% and 71% (p = 0.08). Conclusions: Thick melanomas are frequently ulcerated. Nodular histology predicted sentinel node positivity. The positive sentinel lymph node had a negative impact in survival. Sentinel node biopsy would have prognostic value in these patients.


REFERENCES

  1. Gyorki DE, Sanelli A, Herschtal A, Lazarakis S, McArthur GA, Speakman D et al. Sentinel lymph node biopsy in T4 melanoma: an important risk-stratification tool. Ann Surg Oncol. 2016; 23: 579-584.

  2. Morton DL, Wen DR, Cochran AJ. Management of early-stage melanoma by intraoperative lymphatic mapping and selective lymphadenectomy: an alternative to routine elective lymphadenectomy or “Watch and Wait”. Surg Oncol Clin North Am. 1992; 1: 247-259

  3. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992; 127: 239-259.

  4. Zippel DB, Shapira R, Kuchuk I, Goitein D, Winkler E, Papa MZ et al. Outcome of thick (> 4 mm) node-negative melanomas. Isr Med Assoc J. 2009; 11: 669-672.

  5. Morton DL, Cochran AJ, Thompson JF, Elashoff R, Essner R, Glass EC et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005; 242: 302-311.

  6. Balch CM, Gershenwald JE, Soong SJ et al. Melanoma of the skin. In: Edge SB, Byrd DR, Compton CC, editors. AJCC staging manual. 7th edition. New York: Springer; 2010. p. 325-344.

  7. Haddadd FF, Costello D, Reintgen DS. Radioguided surgery for melanoma. Surg Oncol Clin N Am. 1999; 8 (3): 413-426.

  8. National Comprehensive Cancer Network. Melanoma. Version 2.2016. [Accessed 17 May of 2016] Available in: https://www.nccn.org/professionals/physician_gls/pdf/melanoma_blocks.pdf.

  9. Meguerditchian AN, Asubonteng K, Young C, Lema B, Wilding G, Kane JM 3r. Thick primary melanoma has a heterogeneous tumor biology: an institutional series. World J Surg Oncol. 2011; 9: 40-46.

  10. Cabanas RM. An approach for the treatment of penile carcinoma. Cancer. 1977; 39 (2): 456-466.

  11. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014; 370 (7): 599-609.

  12. Madu MF, Wouters MWJM, van Akkooi ACJ. Sentinel node biopsy in melanoma: current controversies addressed. Eur J Surg Oncol. 2017; 43 (3): 517-533.

  13. Kachare SD, Singla P, Vohra NA, Zervos EE1, Wong JH1, Fitzgerald TL. Sentinel lymph node biopsy is prognostic but not therapeutic in thick melanoma. Surgery. 2015; 158 (3): 662-668.

  14. Gajdos C, Griffith KA, Wong SL, Johnson TM, Chang AE, Cimmino VM et al. Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma? Cancer. 2009; 115 (24): 5752-5760.

  15. Ribero S, Osella-Abate S, Sanlorenzo M, Balagna E, Senetta R, Fierro MT et al. Sentinel lymph node biopsy in thick-melanoma patients (n = 350): what is its prognostic role? Ann Surg Oncol. 2015; 22: 1967-1973.

  16. Yamamoto M, Fisher KJ, Wong JY, Koscso JM, Konstantinovic MA, Govsyeyev N et al. Sentinel lymph node biopsy is indicated for patients with thick clinically lymph node-negative melanoma. Cancer. 2015; 121 (10): 1628-1636.

  17. Goppner D, Ulrich J, Pokrywka A, Peters B, Gollnick H, Leverkus M. Sentinel lymph node biopsy status is a key parameter to stratify the prognostic heterogeneity of malignant melanoma in high-risk tumors > 4.0 mm. Dermatology. 2011; 222 (1): 59-66.

  18. Fairbairn NG, Orfaniotis G, Butterworth M. Sentinel lymph node biopsy in thick malignant melanoma: a 10-year single unit experience. J Plast Reconstr Aesthet Surg. 2012; 65 (10): 1396-1402.

  19. Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017; 376 (23): 2211-2222.




2020     |     www.medigraphic.com