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Sentinel Lymph Node Biopsy for Eyelid and Conjunctival Malignancies

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Clinical Ophthalmic Oncology

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Abstract

In the 1990s, the technique of sentinel lymph node (SLN) biopsy was developed as a less morbid alternative to elective lymphadenectomy. SLN biopsy is based on the principle that cutaneous lesions drain to the regional lymph nodes before metastasizing distantly and that the disease status of the first node or first few nodes in the lymphatic chain to which the tumor drains carries valuable prognostic information. As many malignancies in the periocular region have the potential to metastasize to the regional lymph nodes, sentinel lymph node biopsy has been evaluated for identification of early microscopic lymph node metastasis in patients with cancers of the eyelid and conjunctiva. This chapter summarizes the anatomic and technical considerations and indications for SLN biopsy in the periocular region and will review the published reports to date on this topic and important relevant recent reports on sentinel lymph node biopsy in general and also on implications for adjuvant therapy particularly for melanoma patients.

The authors of the chapter would like to thank Dr. Vivian T. Yin for her contribution towards previous edition of this chapter.

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References

  1. Bennett LR, Lago G. Cutaneous lymphoscintigraphy in malignant melanoma. Semin Nucl Med. 1983;13(1):61–9.

    CAS  PubMed  Google Scholar 

  2. Wanebo HJ, Harpole D, Teates CD. Radionuclide lymphoscintigraphy with technetium 99m antimony sulfide colloid to identify lymphatic drainage of cutaneous melanoma at ambiguous sites in the head and neck and trunk. Cancer. 1985;55(6):1403–13.

    CAS  PubMed  Google Scholar 

  3. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127(4):392–9.

    CAS  PubMed  Google Scholar 

  4. Alex JC, Krag DN. Gamma-probe guided localization of lymph nodes. Surg Oncol. 1993;2(3):137–43.

    CAS  PubMed  Google Scholar 

  5. Glass LF, Messina JL, Cruse W, et al. The use of intraoperative radiolymphoscintigraphy for sentinel node biopsy in patients with malignant melanoma. Dermatol Surg. 1996;22(8):715–20.

    CAS  PubMed  Google Scholar 

  6. Esmaeli B. Sentinel lymph node mapping for patients with cutaneous and conjunctival malignant melanoma. Ophthal Plast Reconstr Surg. 2000;16(3):170–2.

    CAS  PubMed  Google Scholar 

  7. Cook BE Jr, Lucarelli MJ, Lemke BN, et al. Eyelid lymphatics I: histochemical comparisons between the monkey and human. Ophthal Plast Reconstr Surg. 2002;18(1):18–23.

    PubMed  Google Scholar 

  8. Cook BE Jr, Lucarelli MJ, Lemke BN, et al. Eyelid lymphatics II: a search for drainage patterns in the monkey and correlations with human lymphatics. Ophthal Plast Reconstr Surg. 2002;18(2):99–106.

    PubMed  Google Scholar 

  9. Nijhawan N, Marriott C, Harvey JT. Lymphatic drainage patterns of the human eyelid: assessed by lymphoscintigraphy. Ophthal Plast Reconstr Surg. 2010;26(4):281–5.

    PubMed  Google Scholar 

  10. Valdes Olmos RA, Hoefnagel CA, Nieweg OE, et al. Lymphoscintigraphy in oncology: a rediscovered challenge. Eur J Nucl Med. 1999;26(4 Suppl):S2–s10.

    CAS  PubMed  Google Scholar 

  11. Veenstra HJ, Vermeeren L, Olmos RA. The additional value of lymphatic mapping with routine SPECT/CT in unselected patients with clinically localized melanoma. Ann Surg Oncol. 2012;19:1018–23.

    PubMed  Google Scholar 

  12. Stoffels I, Boy C, Poppel T, et al. Association between sentinel lymph node excision with or without preoperative SPECT/CT and metastatic node detection and disease-free survival in melanoma. JAMA. 2012;308:1007–14.

    CAS  PubMed  Google Scholar 

  13. Kramer EL. Lymphoscintigraphy: radiopharmaceutical selection and methods. Nucl Med Biol. 1990;17:57–63.

    CAS  Google Scholar 

  14. Tonakie A, Sondak V, Yahanda A. Reproducibility of lymphoscintigraphic drainage patterns in sequential 99mTc human serum albumin and 99mTc sulfur colloid studies: implication for sentinel node identification in melanoma. Surgery. 2000;127:955–62.

    Google Scholar 

  15. Esmaeli B, Eicher S, Popp J. Sentinel lymph node biopsy for conjunctival melanoma. Ophthal Plast Reconstr Surg. 2001;17:436–42.

    CAS  PubMed  Google Scholar 

  16. Amato M, Esmaeli B, Ahmadi MA. Feasibility of preoperative lymphoscintigraphy for identification of sentinel lymph nodes in patients with conjunctival and periocular skin malignancies. Ophthal Plast Reconstr Surg. 2003;19:102–6.

    PubMed  Google Scholar 

  17. Mar MV, Miller SA, Kim E. Evaluation and localization of lymphatic drainage and sentinel lymph nodes in patients with head and neck melanomas by hybrid SPECT/CT lymphoscintigraphic imaging. J Nucl Med Technol. 2007;35:10–6.

    PubMed  Google Scholar 

  18. Prieto CG, Clark SH. Processing of sentinel lymph nodes for detection of metastatic melanoma. Ann Diagn Pathol. 2002;6:257–64.

    PubMed  Google Scholar 

  19. Allen PJ, Busam K, Hill AD. Immunohistochemical analysis of sentinel nodes from patients with Merkel cell carcinoma. Cancer. 2001;92:1650–5.

    CAS  PubMed  Google Scholar 

  20. Ansai S, Takeichi H, Arase S, et al. Sebaceous carcinoma: an immunohistochemical reappraisal. Am J Dermatopathol. 2011;33:579–87.

    Google Scholar 

  21. Satzger I, Meier A, Hoy L. Sentinel node dissection delays recurrence and prolongs melanoma-related survival: an analysis of 673 patients from a single center with long-term follow-up. Ann Surg Oncol. 2011;18:514–20.

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376(23):2211–22.

    PubMed  PubMed Central  Google Scholar 

  24. Esmaeli B, Youssef A, Naderi A, et al. Margins of excision for cutaneous melanoma of the eyelid skin: the Collaborative Eyelid Skin Melanoma Group Report. Ophthal Plast Reconstr Surg. 2003;19(2):96–101.

    PubMed  Google Scholar 

  25. Yin VT, Warneke CL, Merritt HA, et al. Number of excisions required to obtain clear surgical margins and prognostic value of AJCC T category for patients with eyelid melanoma. Br J Ophthalmol. 2014;98(12):1681–5.

    PubMed  Google Scholar 

  26. Chan FM, O’Donnell BA, Whitehead K, et al. Treatment and outcomes of malignant melanoma of the eyelid: a review of 29 cases in Australia. Ophthalmology. 2007;114(1):187–92.

    PubMed  Google Scholar 

  27. Pfeiffer ML, Ozgur OK, Myers JN, et al. Sentinel lymph node biopsy for ocular adnexal melanoma. Acta Ophthalmol. 2017;95(4):e323–8.

    CAS  PubMed  Google Scholar 

  28. Nijhawan N, Ross MI, Diba R, et al. Experience with sentinel lymph node biopsy for eyelid and conjunctival malignancies at a cancer center. Ophthalmic Plast Reconstr Surg. 2004;20(4):291–5.

    PubMed  Google Scholar 

  29. Ho VH, Ross MI, Prieto VG, et al. Sentinel lymph node biopsy for sebaceous cell carcinoma and melanoma of the ocular adnexa. Arch Otolaryngol. 2007;133(8):820–6.

    Google Scholar 

  30. Savar A, Ross MI, Preito VG. Sentinel lymph node biopsy for ocular adnexal melanoma: experience in 30 patients. Ophthalmology. 2009;116:2217–23.

    PubMed  Google Scholar 

  31. Cohen VM, Tsimpida M, Hungerford JL, et al. Prospective study of sentinel lymph node biopsy for conjunctival melanoma. Br J Ophthalmol. 2013;97(12):1525–9.

    PubMed  PubMed Central  Google Scholar 

  32. Shields CL. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Trans Am Ophthalmol Soc. 2000;98:471–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Missotten GS, Keijser S, De Keizer RJ, et al. Conjunctival melanoma in the Netherlands: a nationwide study. Invest Ophthalmol Vis Sci. 2005;46(1):75–82.

    PubMed  Google Scholar 

  34. Aziz HA, Gastman BR, Singh AD. Management of Conjunctival Melanoma: Critical Assessment of Sentinel Lymph Node Biopsy. Ocul Oncol Pathol. 2015;1(4):266–73.

    PubMed  PubMed Central  Google Scholar 

  35. Francis IC, Benecke PS, Kappagoda MB. A ten-year hospital survey of eyelid cancer. Aust J Ophthalmol. 1984;12:121–7.

    CAS  PubMed  Google Scholar 

  36. Faustina M, Diba R, Ahmadi A. Pattern of regional and distant metastasis in patients with eyelid and periocular squamous cell carcinoma. Ophthalmology. 2004;111:1930–2.

    PubMed  Google Scholar 

  37. Nasser QJ, Roth KG, Warneke CL, et al. Impact of AJCC 'T' designation on risk of regional lymph node metastasis in patients with squamous carcinoma of the eyelid. Br J Ophthalmol. 2014;98(4):498–501.

    PubMed  Google Scholar 

  38. Ahadiat O, Higgins S, Sutton A, et al. SLNB in cutaneous SCC: a review of the current state of literature and the direction for the future. J Surg Oncol. 2017;116(3):344–50.

    PubMed  Google Scholar 

  39. Reschly MJ, Messina JL, Zaulyanov LL, et al. Utility of sentinel lymphadenectomy in the management of patients with high-risk cutaneous squamous cell carcinoma. Dermatol Surg. 2003;29(2):135–40.

    PubMed  Google Scholar 

  40. Ross AS, Schmults CD. Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature. Dermatol Surg. 2006;32(11):1309–21.

    CAS  PubMed  Google Scholar 

  41. Renzi C, Caggiati A, Mannooranparampil TJ, et al. Sentinel lymph node biopsy for high risk cutaneous squamous cell carcinoma: case series and review of the literature. Eur J Surg Oncol. 2007;33(3):364–9.

    CAS  PubMed  Google Scholar 

  42. Takahashi A, Imafuku S, Nakayama J, et al. Sentinel node biopsy for high-risk cutaneous squamous cell carcinoma. Eur J Surg Oncol. 2014;40(10):1256–62.

    CAS  PubMed  Google Scholar 

  43. Durham AB, Lowe L, Malloy KM, et al. Sentinel lymph node biopsy for cutaneous squamous cell carcinoma on the head and neck. JAMA Otolaryngol. 2016;142(12):1171–6.

    Google Scholar 

  44. Maalouf TJ, Dolivet G, Angioi KS. Sentinel lymph node biopsy in patients with conjunctival and eyelid cancers: experience in 17 patients. Ophthal Plast Reconstr Surg. 2012;28:30–4.

    PubMed  Google Scholar 

  45. Chak G, Morgan PV, Joseph JM, et al. A positive sentinel lymph node in periocular invasive squamous cell carcinoma: a case series. Ophthal Plast Reconstr Surg. 2013;29(1):6–10.

    PubMed  Google Scholar 

  46. Shields JA, Demirci H, Marr BP. Sebaceous carcinoma of the eyelids: personal experience with 60 cases. Ophthalmology. 2004;111:2151–7.

    PubMed  Google Scholar 

  47. Esmaeli B, Nasser QJ, Cruz H, et al. American Joint Committee on Cancer T category for eyelid sebaceous carcinoma correlates with nodal metastasis and survival. Ophthalmology. 2012;119(5):1078–82.

    PubMed  Google Scholar 

  48. Connor M, Droll L, Ivan D. Management of perineural invasion in sebaceous carcinoma of the eyelid. Ophthal Plast Reconstr Surg. 2011;27:356–9.

    PubMed  Google Scholar 

  49. Agelli M, Clegg LX. Epidemiology of primary Merkel cell carcinoma in the United States. J Am Acad Dermatol. 2003;49:832–41.

    PubMed  Google Scholar 

  50. Donepudi S, DeConti RC, Samlowski WE. Recent advances in the understanding of the genetics, etiology, and treatment of Merkel cell carcinoma. Semin Oncol. 2012;39:163–72.

    CAS  PubMed  Google Scholar 

  51. Lemos BD, Storer BE, Iyer JG. Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as basis of the first consensus staging system. J Am Acad Dermatol. 2010;63:751–61.

    PubMed  PubMed Central  Google Scholar 

  52. Sims JR, Grotz TE, Pockaj BA, et al. Sentinel lymph node biopsy in Merkel cell carcinoma: The Mayo Clinic experience of 150 patients. Surg Oncol. 2018;27(1):11–7.

    PubMed  Google Scholar 

  53. Peters GB, Meyer DR, Shields JA. Management and prognosis of Merkel cell carcinoma of the eyelid. Ophthalmology. 2001;108:1575–9.

    PubMed  Google Scholar 

  54. Esmaeli B, Naderi A, Hidaji L. Merkel cell carcinoma of the eyelid with a positive sentinel node. Arch Ophthalmol. 2002;120:646–8.

    PubMed  Google Scholar 

  55. Sniegowski MC, Warneke CL, Morrison WH, et al. Correlation of American Joint Committee on Cancer T category for eyelid carcinoma with outcomes in patients with periocular Merkel cell carcinoma. Ophthal Plast Reconstr Surg. 2014;30(6):480–5.

    PubMed  Google Scholar 

  56. Herbert HM, Sun MT, Selva D, et al. Merkel cell carcinoma of the eyelid: management and prognosis. JAMA Ophthalmol. 2014;132(2):197–204.

    PubMed  Google Scholar 

  57. Nghiem PT, Bhatia S, Lipson EJ, et al. PD-1 blockade with pembrolizumab in advanced Merkel-cell carcinoma. N Engl J Med. 2016;374(26):2542–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Kaufman HL, Russell J, Hamid O, et al. Avelumab in patients with chemotherapy-refractory metastatic Merkel cell carcinoma: a multicentre, single-group, open-label, phase 2 trial. Lancet Oncol. 2016;17(10):1374–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Cigna E, Gradilone A, Ribuffo D. Morbidity of selective lymph node biopsy for melanoma: meta-analysis of complications. Tumori. 2012;98:94–8.

    PubMed  Google Scholar 

  60. Wasserberg N, Tulchinsky H, Schachter J. Sentinel-lymph-node biopsy for melanoma is not complication-free. Eur Oncol. 2004;30:851–6.

    Google Scholar 

  61. Troyan SL, Kianzad V, Gibbs-Strauss SL. The F. intraoperative near-infrared fluorescence imaging system: a first-in-human clinical trial in breast cancer sentinel lymph node mapping. Ann Surg Oncol. 2009;16:2943–52.

    PubMed  PubMed Central  Google Scholar 

  62. Sugie T, Sawada T, Tagaya N. Comparison of the indocyanine green fluorescence and blue dye methods in detection of sentinel lymph nodes in early-stage breast cancer. Ann Surg Oncol. 2013;20:2213–8.

    PubMed  Google Scholar 

  63. Rubinstein TJ, Perry JD, Korn JM, et al. Indocyanine green-guided sentinel lymph node biopsy for periocular tumors. Ophthalmic Plast Reconstr Surg. 2014;30(4):301–4.

    PubMed  Google Scholar 

  64. McMasters K, Swetter SM. Current management of melanoma: benefits of surgical staging and adjuvant therapy. J Surg Oncol. 2003;82:209–16.

    PubMed  Google Scholar 

  65. Elias N, Tanabe KK, Sober AJ. Is completion lymphadenectomy after a positive sentinel lymph node biopsy for cutaneous melanoma always necessary? Arch Surg. 2004;139:400–5.

    PubMed  Google Scholar 

  66. Yasuhiro F, Otsuka F. Japanese Melanoma Study Group. The benefit of a sentinel lymph node biopsy and adjuvant therapy in thick 4 mm melanoma multicenter retrospective study of 291 Japanese patients. Melanoma Res. 2012;22:362–7.

    Google Scholar 

  67. Mendenhall WM, Amdur RJ, Grobmyer SR. Adjuvant radiotherapy for cutaneous melanoma. Cancer. 2008;112:1189–96.

    PubMed  Google Scholar 

  68. D’Souza J, Clark J. Management of neck in metastatic cutaneous squamous cell carcinoma of the head and neck. Curr Opin Otolaryngol Head Neck Surg. 2011;19:99–105.

    PubMed  Google Scholar 

  69. Yen MT, Tse DT, Wu X. Radiation therapy for local control of eyelid sebaceous cell carcinoma: report of two cases and review of literature. Ophthal Plast Reconstr Surg. 2000;16:211–5.

    CAS  PubMed  Google Scholar 

  70. Hedina-Franco H, Urist MM. Multimodality treatment of Merkel cell carcinoma: case series and literature review of 1024 cases. Ann Surg Oncol. 2001;8:204–8.

    Google Scholar 

  71. Sondak VK, Wolfe JA. Adjuvant therapy for melanoma. Curr Opin Oncol. 1997;9:189–204.

    CAS  PubMed  Google Scholar 

  72. Eggermont AMM, Gore M. Randomized adjuvant therapy trials in melanoma: surgical and systemic. Semin Oncol. 2007;34:509–15.

    PubMed  Google Scholar 

  73. Kirkwood JM, Ibrahim JG, Sosman JA. High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIb-III melanoma: results of intergroup trial E1694/S9512/C509801. J Clin Oncol. 2001;19:2370–80.

    CAS  PubMed  Google Scholar 

  74. Hodi FS, O’Day SJ, McDermott DF, et al. Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010;363(8):711–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  75. Larkin J, Chiarion-Sileni V, Gonzalez R, et al. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med. 2015;373(1):23–34.

    PubMed  PubMed Central  Google Scholar 

  76. Hamid O, Robert C, Daud A, et al. Safety and tumor responses with lambrolizumab (anti–PD-1) in melanoma. N Engl J Med. 2013;369(2):134–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  77. Taube JM, Galon J, Sholl LM, et al. Implications of the tumor immune microenvironment for staging and therapeutics. Mod Pathol. 2018;31(2):214–34.

    CAS  PubMed  Google Scholar 

  78. Ford J, Thuro BA, Thakar S, et al. Immune checkpoint inhibitors for treatment of metastatic melanoma of the orbit and ocular adnexa. Ophthal Plast Reconstr Surg. 2017;33(4):e82–5.

    PubMed  Google Scholar 

  79. Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355(13):1307–17.

    CAS  PubMed  Google Scholar 

  80. Esmaeli B, Roberts D, Ross M. Histologic features of conjunctival melanoma predictive of metastasis and death. Trans Am Ophthalmol Soc. 2012;110:64–73.

    PubMed  PubMed Central  Google Scholar 

  81. Tuomaala S, Kivela T. Metastatic pattern and survival in disseminated conjunctival melanoma: implications for sentinel lymph node biopsy. Ophthalmology. 2004;111:816–21.

    PubMed  Google Scholar 

  82. Shields CL, Shields JA, Gunduz K. Conjunctival melanoma: risk factors for recurrence, exenteration, metastasis, and death in 150 consecutive patients. Arch Ophthalmol. 2000;118:1497–507.

    CAS  PubMed  Google Scholar 

  83. Esmaeli B. Advances in the management of malignant tumors of the eyelid and conjunctiva: the role of sentinel lymph node biopsy. Int Ophthalmol Clin. 2002;42(2):151–62.

    PubMed  Google Scholar 

  84. Sanchez R, Ivan D, Esmaeli B. Eyelid and periorbital cutaneous malignant melanoma. Int Ophthalmol Clin. 2009;49(4):25–43.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Plastic Surgery, Orbital Oncology and Ophthalmic Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Oded Sagiv & Bita Esmaeli

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  1. Oded Sagiv
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  2. Bita Esmaeli
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Correspondence to Bita Esmaeli .

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Editors and Affiliations

  1. Ocular Onocology Service and Ophthalmic Pathology Laboratory, Department of Ophthalmology, Hadassah - Hebrew University Medical Center, Jerusalem, Israel

    Jacob Pe'er

  2. Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

    Arun D. Singh

  3. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK

    Bertil E. Damato

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Sagiv, O., Esmaeli, B. (2019). Sentinel Lymph Node Biopsy for Eyelid and Conjunctival Malignancies. In: Pe'er, J., Singh, A., Damato, B. (eds) Clinical Ophthalmic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-06046-6_21

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