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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Acknowledgment
This project received a Grant from the Friends of the Mater Foundation, North Sydney NSW. LHJH received a research grant from the Groningen Melanoma and Sarcoma Foundation and was funded by het Vreedefonds and Melanoma Institute Australia. The authors gratefully acknowledge the support and assistance of colleagues at the Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and Melanoma Institute Australia. Funding support from the National Health and Medical Research Council, Cancer Institute New South Wales, Melanoma Institute Australia, and The Melanoma Foundation of the University of Sydney is also gratefully acknowledged. R.A.S. is a National Health and Medical Research Council Practitioner Fellow, and R.V. is supported by a Cameron Fellowship through Melanoma Institute Australia. J.F.T. is supported by the Melanoma Foundation of the University of Sydney.
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Holtkamp, L.H.J., Wang, S., Wilmott, J.S. et al. Detailed Pathological Examination of Completion Node Dissection Specimens and Outcome in Melanoma Patients with Minimal (<0.1 mm) Sentinel Lymph Node Metastases. Ann Surg Oncol 22, 2972–2977 (2015). https://doi.org/10.1245/s10434-015-4615-z
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DOI: https://doi.org/10.1245/s10434-015-4615-z