Challenges and Variables Affecting the Success of Sentinel Lymph Node Biospy in Malignant Melanoma a 4-Year Analysis of Clinical Results

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Summary

In the last 15 years, sentinel lymph node biopsy (SLNB) for patients with malignant melanoma (MM) has been introduced into the clinical practice. Our aim was to make a retrospective analysis of clinical results in order to assess the success ratio of SLNB and the variables affecting it in MM patients, treated in the Oncology Center at the University Hospital “Dr George Stranski” - Pleven, Bulgaria for a 4-year period. A research index card was used to process the oncologic files of 82 out of 102 patients with MM, treated and monitored at the Oncology centre between 01.01.2008 and 31.12.2011. TNM-stages, Breslow and Clark levels, location, characteristics of the skin lesion, diagnostic excision, type of lymph node dissection, number of SLN, localization of SLN, etc. were registered in the index card. SLNB staging was carried out in 28 patients. Sentinel lymph nodes were found in 22 of them. The success ratio of the method was 78.6%. Histologically, metastatic SLN were found in 4 cases. The Patent Blue Dye method was used in 22 of the cases (78%). A combined radiocolloid and dye method was used in 5 cases (18%). A radiocolloid method was used in 1 case (4%) only. Our research showed that more therapeutic lymph node dissections were performed in cases of locally advanced MM, which in turn worsened the clinical results. According to our research, the SLNB success ratio depends on the precision of diagnostic excision (p=0.019), lesion location (p=0.015), Clark level (p=0.0229), mapping method (p=0.08) and the type of melanoma (p=0.088).

1. Wikipedia, the Free Encyclopedia [Internet], Melanoma, [cited 2013Jan 18]. Available from: http://en.wikipedia.org/wiki/Melanoma

2. Dimitrova N, Vukov M, Valerianova Z, editors. Cancer incidence in Bulgaria 2009. Vol XX. Bulgarian National Cancer Registry: Publisher “AVIS-24” Ltd.; 2011.

3. North JH Jr, Spellman JE. Role of sentinel node biopsy in the management of malignant melanoma. Oncology (Huntington). 1996; 10(8): 1237-42.

4. Lingam MK, Mackie RM, McKay AJ. Intraoperative identification of sentinel node in patients with malignant melanoma. Br J Cancer. 1997;75( 10): 1505-8.

5. James WD, Berger TG, Elston DM. Melanocytic nevi and neoplasms. In: Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. Saunders Elsevier; 2011.p.675-93.

6. Sanchez RL, Raimer S. Pigmentary disturbances and melanocytic tumors. In: Sanchez RL, Raimer S, editors. Vademecum Dermatopathology. Georgetown, Texas: Landes Bioscience: 2001. p. 270-85.

7. Marghoob AA, Koenig K, Bittencourt FV, Kopf AW, Bart RS. Breslow thickness and Clark level in melanoma: support for including level in pathology reports and American Joint Committee on Cancer Staging. Cancer. 2000;88(3):589-95.

8. Testoril A, Rutkowski P, Marsden J, Bastholt L, Chiarion-Sileni V, Hauschild A, et al. Surgery and radiotherapy in the treatment of cutaneous melanoma. Ann Oncol. 2009;20(Suppl 6):vi22-vi29.

9. Jakub JW, Pendas S, Reintgen DS. Current Status of Sentinel Lymph Node Mapping and Biopsy: Facts and Controversies. Oncologist. 2003;8(1): 59-68.

10. McKenna DB, Marioni JC, Lee RJ, Prescott RJ, Doherty VR. A comparison of dermatologists', surgeons' and general practitioners' surgical management of cutaneous melanoma. Br J Dermatol. 2004; 151 (3):636-44.

11. Morton DL, Thompson JF, Essner R, Elashoff R, Stem S, Nieweg O, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma. Ann Surg. 1999;230(4):453-63.

12. Bostick P, Esner R, Glass E. Comparison of Blue Dye and Probe-Assisted Intraoperative Lymphatic Mapping in Melanoma to Identity Sentinel Nodes in 100 Lymphatic Basins. Arch Surg. 1999; 134(l):43-9.

13. O’Brien CJ, Uren RF, Thompson JF, Howman-Giles RB, Petersen-Schaefer K, Shaw HM, et al. Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy. Am J Surg. 1995; 170(5):461 -6.

14. Uren RF, Howman-Giles R, Thompson JF. Patterns of Lymphatic Drainage from the Skin in Patients with Melanoma. J Nucl Med. 2003;44(4):570-82.

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