Abstract
Background. Sentinel lymph node biopsy (SLNB) has rapidly evolved into the standard of care for
clinically node-negative melanoma. Since adopting sentinel lymph node (SLN) technology
in 1993, we have periodically reviewed our institution's results and made several
modifications. Methods. From January 1993 to December 1998, 182 patients with clinically node-negative primary
cutaneous melanoma underwent SLNB. Charts were retrospectively reviewed and assessed
for the technique for the identification of the SLN, the pathologic analysis, and
the use of intraoperative frozen section. Results. The accuracy of SLN identification improved from 91% to 100% with the combination
of isosulfan blue dye and radiolabeled colloid over isosulfan blue dye alone. Routine
versus selective lymphoscintigraphy identified 7 in-transit SLNs and increased detection
of dual nodal basin drainage (15%-27%). Identification of micrometastases in the SLN
increased from 14% to 24% after a modification of pathologic evaluation. The positive
SLN was the only involved node in most patients (80%). Intraoperative frozen section
had a sensitivity of 58% and was of benefit in only 13 of 124 patients (10%). Conclusions. Several modifications to the identification of the SLNs and the detection of metastatic
melanoma have improved our outcome with SLNB. A careful, periodic review of results
to identify areas for improvement at each institution is crucial to the success of
SLNB for melanoma. (Surgery 2000;128:556-63.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer statistics, 2000.CA Cancer J Clin. 2000; 50: 7-33
- The case for elective lymphadenectomy.Surg Oncol Clin N Am. 1992; 1: 205-222
- Lymphatic mapping and sentinel node biopsy in patients with malignant melanoma.J Fla Med Assoc. 1997; 84: 188-193
- Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg. 1992; 127: 392-399
- Prognostic factors in patients with melanoma metastatic to axillary or inguinal lymph nodes.Ann Surg. 1991; 214: 627-636
- An analysis of prognostic factors in 8500 patients with cutaneous melanoma.in: 2nd ed. Cutaneous melanoma. Lippincott, Philadelphia1992: 165-187
- Malignant melanoma of the trunk: a retrospective review of 1128 patients.Cancer. 1982; 49: 1070-1078
- A comparison of prognostic factors and surgical results in 186 patients with localized melanoma treated in Alabama, USA and New South Wales, Australia.Ann Surg. 1982; 196: 677-684
- Patterns of relapse in 1001 consecutive patients with melanoma nodal metastases.Arch Surg. 1989; 124: 1051-1055
- Efficacy of elective lymph node dissection in patients with intermediate thickness primary melanoma.Ann Surg. 1983; 198: 379-385
- Prophylactic lymph node dissection in clinical stage I cutaneous malignant melanoma: results of surgical treatment in 1319 patients.Br J Surg. 1982; 69: 108-111
- Cutaneous melanoma: prognosis and treatment results worldwide.Semin Surg Oncol. 1992; 8: 400-414
- Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malingant melanoma.Am J Surg. 1991; 162: 432-437
- Lymphatic mapping and sentinel lymphadenectomy.in: 3rd ed. Cutaneous melanoma. Quality Medical Publishing, St. Louis, (Mo)1998: 224-227
- Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid.Surgery. 1998; 124: 204-210
- Minimal access surgery for staging of malignant melanoma.Arch Surg. 1995; 130: 654-658
- Intraoperative radio lymphoscintigraphy improves sentinel lymph node identification for patients with melanoma.Ann Surg. 1996; 223: 217-224
- More rational and conservative surgical strategies for malignant melanoma using lymphatic mapping and sentinel node biopsy techniques.Curr Opin Oncol. 1996; 8: 152-158
- Occult tumor cells in lymph nodes of patients with pathological stage I malignant melanoma: an immunohistological study.Am J Surg Pathol. 1988; 12: 612-618
- Accuracy of pathologic techniques for the diagnosis of metastatic melanoma in sentinel lymph nodes.Ann Surg Oncol. 1999; 6: 699-704
Article info
Footnotes
*Reprint requests: William G. Kraybill, MD, Division of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Sts, Buffalo, NY 14263.
**Surgery 2000;128:556-63
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
