Skip to main content
SpringerLink
Log in

Radioguided Sentinel Lymph Node Mapping and Biopsy in Cutaneous Melanoma

  • Chapter
  • First Online:
Radioguided Surgery

Abstract

Sentinel lymph node biopsy has developed into a routine procedure to stage patients with a clinically localized melanoma. The node can be found in almost every patient. The status of the lymph nodes is the most powerful prognostic factor. Although high false-negative rates are still being published, sentinel lymph node biopsy is reliable when performed by an experienced multidisciplinary team using a meticulous technique. The Multicenter Selective Lymphadenectomy Trial I has shown that the procedure leads to improved survival when combined with completion lymph node dissection in lymph node-positive patients with an intermediate Breslow thickness melanoma. The technique of sentinel lymph node biopsy continues to evolve and its importance will expand even further when adequate adjuvant systemic therapies become available.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Cancer Council New South Wales. http://www.cancercouncil.com.au/melanoma/2015.

  2. Hollestein LM, van den Akker SA, Nijsten T, Karim-Kos HE, Coebergh JW, de Vries E. Trends of cutaneous melanoma in the Netherlands: increasing incidence rates among all Breslow thickness categories and rising mortality rates since 1989. Ann Oncol. 2012;23:524–30.

    Article  CAS  PubMed  Google Scholar 

  3. Veronesi U, Adamus J, Bandiera DC, Brennhovd IO, Caceres E, Cascinelli N, et al. Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities. Cancer. 1982;49:2420–30.

    Article  CAS  PubMed  Google Scholar 

  4. Sim FH, Taylor WF, Pritchard DJ, Soule EH. Lymphadenectomy in the management of stage I malignant melanoma: a prospective randomized study. Mayo Clin Proc. 1986;61:697–705.

    Article  CAS  PubMed  Google Scholar 

  5. Balch CM, Soong SJ, Bartolucci AA, Urist MM, Karakousis CP, Smith TJ, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg. 1996;224:255–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cascinelli N, Morabito A, Santinami M, Mackie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomized trial. WHO melanoma programme. Lancet. 1998;351:793–6.

    Article  CAS  PubMed  Google Scholar 

  7. Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19:3622–34.

    CAS  PubMed  Google Scholar 

  8. Morton DL, Hoon DS, Cochran AJ, Turner RR, Essner R, Takeuchi H, et al. Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases. Ann Surg. 2003;238:538–49.

    PubMed  PubMed Central  Google Scholar 

  9. Kretschmer L, Hilgers R, Mohrle M, Balda BR, Breuninger H, Konz B, et al. Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphonodectomy and early excision of their nodal disease. Eur J Cancer. 2004;40:212–8.

    Article  CAS  PubMed  Google Scholar 

  10. Starz H, Siedlecki K, Balda BR. Sentinel lymphonodectomy and s-classification: a successful strategy for better prediction and improvement of outcome of melanoma. Ann Surg Oncol. 2004;11(3 Suppl):162S–8.

    Article  PubMed  Google Scholar 

  11. Nowecki ZI, Rutkowski P, Michej W. The survival benefit to patients with positive sentinel node melanoma after completion lymph node dissection may be limited to the subgroup with a primary lesion Breslow thickness greater than 1.0 and less than or equal to 4 mm (pT2-pT3). Ann Surg Oncol. 2008;15:2223–34.

    Article  PubMed  Google Scholar 

  12. 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;127:392–9.

    Article  CAS  PubMed  Google Scholar 

  13. Uren RF, Howman-Giles R, Thompson JF, Shaw HM, Quinn MJ, O’Brien CJ, et al. Lymphoscintigraphy to identify sentinel lymph nodes in patients with melanoma. Melanoma Res. 1994;4:395–9.

    Article  CAS  PubMed  Google Scholar 

  14. Morton DL, Bostick PJ. Will the true sentinel node please stand? Ann Surg Oncol. 1999;6:12–4.

    Article  CAS  PubMed  Google Scholar 

  15. Balch CM, Ross MI. Sentinel lymphadenectomy for melanoma – is it a substitute for elective lymphadenectomy? Ann Surg Oncol. 1999;6:416–7.

    Article  CAS  PubMed  Google Scholar 

  16. Thompson JF, Uren RF. What is a ‘sentinel’ lymph node? Eur J Surg Oncol. 2000;26:103–4.

    Article  CAS  PubMed  Google Scholar 

  17. Nieweg OE, Tanis PJ, Kroon BBR. The definition of a sentinel node. Ann Surg Oncol. 2001;9:538–41.

    Article  Google Scholar 

  18. Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M, et al. Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997;349:1864–7.

    Article  CAS  PubMed  Google Scholar 

  19. De Cicco C, Sideri M, Bartolomei M, Maggioni A, Colombo N, Bocciolone L, et al. Sentinel node detection by lymphoscintigraphy and gamma detecting probe in patients with vulvar cancer. J Nucl Med. 1997;38:33P.

    Google Scholar 

  20. Gershenwald JE, Tseng CH, Thompson W, Mansfield PF, Lee JE, Bouvet M, et al. Improved sentinel lymph node localization in patients with primary melanoma with the use of radiolabeled colloid. Surgery. 1998;124:203–10.

    Article  CAS  PubMed  Google Scholar 

  21. Boxen I, McCready D, Ballinger JR. Sentinel node detection and definition may depend on the imaging agent and timing. Clin Nucl Med. 1999;24:390–4.

    Article  CAS  PubMed  Google Scholar 

  22. Veenstra HJ, Wouters MJWM, Kroon BBR, Valdés Olmos RA, Nieweg OE. Less false-negative sentinel node procedures in melanoma patients with experience and proper collaboration. J Surg Oncol. 2011;104:454–7.

    Article  PubMed  Google Scholar 

  23. Uren RF, Hawman-Giles R, Thompson JF. Variation in cutaneous lymphatic flow rates. Ann Surg Oncol. 1997;4:279–81.

    Article  CAS  PubMed  Google Scholar 

  24. Jansen L. Sentinel node biopsy: evolving from melanoma to breast cancer. PhD thesis. University of Amsterdam; 2000.

    Google Scholar 

  25. Uren RF, Howman-Giles R, Thompson JF, McCarthy WH, Quinn MJ, Roberts JM, et al. Interval nodes: the forgotten sentinel nodes in patients with melanoma. Arch Surg. 2000;135:1168–72.

    Article  CAS  PubMed  Google Scholar 

  26. Valdés Olmos RA, Rietbergen DD, Vidal-Sicart S, Manca G, Giammarile F, Mariani G. Contribution of SPECT/CT imaging to radioguided sentinel lymph node biopsy in breast cancer, melanoma, and other solid cancers: from “open and see” to “see and open”. Q J Nucl Medi Mol Imaging Off Publ Ital Assoc Nucl Med. 2014;58:127–39.

    Google Scholar 

  27. Uren RF. SPECT/CT Lymphoscintigraphy to locate the sentinel lymph node in patients with melanoma. Ann Surg Oncol. 2009;16:1459–60.

    Article  PubMed  Google Scholar 

  28. Van der Ploeg IM, Valdés Olmos RA, Kroon BBR, Wouters MW, van den Brekel MW, Vogel WV, et al. The yield of SPECT/CT for anatomical lymphatic mapping in patients with melanoma. Ann Surg Oncol. 2009;16:1537–42.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  30. Tanis PJ, Hart AAM, Nieweg OE, Kroon BBR. The illusion of a learning phase for lymphatic mapping. Ann Surg Oncol. 2002;9:142–7.

    Article  CAS  PubMed  Google Scholar 

  31. Nieweg OE, Jansen L, Kroon BBR. Technique of lymphatic mapping and sentinel node biopsy for melanoma. Eur J Surg Oncol. 1998;24:520–4.

    Article  CAS  PubMed  Google Scholar 

  32. 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;370:599–609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Gershenwald JE, Thompson W, Mansfield PF, Lee JE, Colome MI, Tseng CH, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17:976–83.

    CAS  PubMed  Google Scholar 

  34. Jansen L, Nieweg OE, Peterse JL, Hoefnagel CA, Valdés Olmos RA, Kroon BBR. Reliability of sentinel lymph node biopsy for staging melanoma. Br J Surg. 2000;87:484–9.

    Article  CAS  PubMed  Google Scholar 

  35. Balch CA, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Estourgie SH, Nieweg OE, Kroon BBR. High incidence of in-transit metastases after sentinel node biopsy in patients with melanoma. Br J Surg. 2004;91:1370–1.

    Article  CAS  PubMed  Google Scholar 

  37. Veenstra HJ, Van der Ploeg IMC, Wouters MWJM, Kroon BBR, Nieweg OE. Reevaluation of the locoregional recurrence rate in melanoma patients with a positive sentinel node compared to patients with palpable nodal involvement. Ann Surg Oncol. 2010;17:521–6.

    Article  PubMed  Google Scholar 

  38. Van Poll D, Thompson JF, Colman MH, McKinnon JG, Saw RP, Stretch JR, et al. A sentinel node biopsy does not increase the incidence of in-transit metastasis in patients with primary cutaneous melanoma. Ann Surg Oncol. 2005;12:597–608.

    Article  PubMed  Google Scholar 

  39. Nieweg OE, Tanis PJ, De Vries JDH, Kroon BBR. Sensitivity of sentinel node biopsy in melanoma. J Surg Oncol. 2001;78:223–4.

    Article  CAS  PubMed  Google Scholar 

  40. Nieweg OE. False-negative sentinel node biopsy. Ann Surg Oncol. 2009;16:2089–91.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Sakowska MM, Smith N, Coutts RJ. Twelve years’ experience of sentinel lymph node biopsy for melanoma at a rural New Zealand hospital. N Z Med J. 2014;127:12–22.

    PubMed  Google Scholar 

  42. Van der Ploeg IMC, Nieweg OE, Van Rijk MC, Valdés Olmos RA, Kroon BBR. Axillary recurrence after a tumour-negative sentinel node biopsy in breast cancer patients: a systematic review and meta-analysis of the literature. Eur J Surg Oncol. 2008;34:1277–84.

    Article  PubMed  Google Scholar 

  43. Karim RZ, Scolyer RA, Li W, Yee VSK, McKinnon JG, Li LXL, et al. False negative sentinel lymph node biopsies in melanoma may result from deficiencies in nuclear medicine, surgery, or pathology. Ann Surg. 2008;247:1003–10.

    Article  PubMed  Google Scholar 

  44. Rosenberg SA. Why perform sentinel-lymph-node biopsy in patients with melanoma? Nat Clin Pract Oncol. 2008;5:1.

    Article  PubMed  Google Scholar 

  45. Thomas JM. Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol. 2008;5:18–23.

    Article  PubMed  Google Scholar 

  46. Morton DL, Cochran AJ, Thompson JF. The rationale for sentinel-node biopsy in primary melanoma. Nat Clin Pract Oncol. 2008;5:510–1.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Garreau JR, Faries MB, Ye X, Morton DL. Mood state and melanoma outcome in the Multicenter Selective Lymphadenectomy Trial. J Clin Oncol. 2009;27:15S, abstract 9603.

    Article  Google Scholar 

  48. Faries MB, Thompson JF, Cochran A, Elashoff R, Glass EC, Mozzillo N, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I). Ann Surg Oncol. 2010;17:3324–9.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Gershenwald JE, Berman RS, Porter G, Mansfield PF, Lee JE, Ross MI. Regional nodal basin control is not compromised by previous sentinel lymph node biopsy in patients with melanoma. Ann Surg Oncol. 2000;7:226–31.

    Article  CAS  PubMed  Google Scholar 

  50. Chao C, Wong SL, Ross MI, Reintgen DS, Noyes RD, Cerrito PB, et al. Patterns of early recurrence after sentinel lymph node biopsy for melanoma. Am J Surg. 2002;184:520–4.

    Article  PubMed  Google Scholar 

  51. Lee RJ, Gibbs JF, Proulx GM, Kollmorgen DR, Jia C, Kraybill WG. Nodal basin recurrence following lymph node dissection for melanoma: implications for adjuvant radiotherapy. Int J Radiat Oncol Biol Phys. 2000;46:467–74.

    Article  CAS  PubMed  Google Scholar 

  52. Gershenwald JE, Ross MI. Sentinel-lymph-node biopsy for cutaneous melanoma. N Engl J Med. 2011;364:1738–45.

    Article  CAS  PubMed  Google Scholar 

  53. Morton DL, Cochran AJ, Thompson JF. Authors’ response to a letter to the editor re: sentinel node biopsy for early-stage melanoma. Ann Surg. 2007;245:828–9.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Morton DL, Elashoff R. Sentinel node biopsy: facts to clear the alleged clouds. Arch Dermatol. 2008;144:685–6.

    Article  PubMed  Google Scholar 

  55. Sanki A, Uren RF, Moncrieff M, Tran KL, Scolyer RA, Lin HY, et al. Targeted high-resolution ultrasound is not an effective substitute for sentinel lymph node biopsy in patients with primary cutaneous melanoma. J Clin Oncol. 2009;27:5614–9.

    Article  PubMed  Google Scholar 

  56. Thompson JF, Cochran AJ, Faries MB. Sentinel-node biopsy in melanoma. N Engl J Med. 2014;370:2149–50.

    CAS  PubMed  PubMed Central  Google Scholar 

  57. Estourgie SH, Nieweg OE, Valdés Olmos RA, Hoefnagel CA, Kroon BBR. Review and evaluation of sentinel node procedures in 250 melanoma patients with a median follow-up of 6 years. Ann Surg Oncol. 2003;10:681–8.

    Article  PubMed  Google Scholar 

  58. Wong SL, Morton DL, Thompson JF, Gershenwald JE, Leong SP, Reintgen DS, et al. Melanoma patients with positive sentinel nodes who did not undergo completion lymphadenectomy: a multi-institutional study. Ann Surg Oncol. 2006;13:809–16.

    Article  PubMed  Google Scholar 

  59. Scheri RP, Essner R, Turner RR, Ye X, Wanek L, Morton DL. Do isolated tumor cells in the sentinel node in melanoma affect long-term prognosis? Ann Surg Oncol. 2007;14 Suppl:11.

    Google Scholar 

  60. Veenstra HJ, Brouwer OR, van der Ploeg IM, Kroon BBR, Nieweg OE. Five-year follow-up of 16 melanoma patients with a Starz I-involved sentinel node in whom completion lymph node dissection was omitted. Melanoma Res. 2012;22:436–9.

    Article  PubMed  Google Scholar 

  61. Vera DR, Wallace AM, Hoh CK. [(99m)Tc]MAG(3)-mannosyl-dextran: a receptor-binding radiopharmaceutical for sentinel node detection. Nucl Med Biol. 2001;28:493–8.

    Article  CAS  PubMed  Google Scholar 

  62. Buckle T, van Leeuwen AC, Chin PT, Janssen H, Muller SH, Jonkers J, et al. A self-assembled multimodal complex for combined pre- and intraoperative imaging of the sentinel lymph node. Nanotechnology. 2010;21:355101.

    Article  PubMed  Google Scholar 

  63. Brouwer OR, Buckle T, Vermeeren L, Klop WM, Balm AJ, van der Poel HG, et al. Comparing the hybrid fluorescent-radioactive tracer indocyanine green-99mTc-nanocolloid with 99mTc-nanocolloid for sentinel node identification: a validation study using lymphoscintigraphy and SPECT/CT. J Nucl Med. 2012;53:1034–40.

    Article  CAS  PubMed  Google Scholar 

  64. Van den Berg NS, Brouwer OR, Schaafsma BE, Matheron HM, Klop WM, Balm AJ, et al. Multimodal surgical guidance during sentinel node biopsy for melanoma: combined gamma tracing and fluorescence imaging of the sentinel node through use of the hybrid tracer indocyanine green-(99m)Tc-Nanocolloid. Radiology. 2015;275:521–9.

    Google Scholar 

  65. Brouwer OR, Klop WM, Buckle T, Vermeeren L, van den Brekel MW, Balm AJ, et al. Feasibility of sentinel node biopsy in head and neck melanoma using a hybrid radioactive and fluorescent tracer. Ann Surg Oncol. 2012;19:1988–94.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Vermeeren L, Valdés Olmos RA, Klop WM, van der Ploeg IM, Nieweg OE, Balm AJ, et al. SPECT/CT for sentinel lymph node mapping in head and neck melanoma. Head Neck. 2011;33:1–6.

    Article  PubMed  Google Scholar 

  67. Wendler T, Herrmann K, Schnelzer A, Lasser T, Traub J, Kutter O, et al. First demonstration of 3-D lymphatic mapping in breast cancer using freehand SPECT. Eur J Nucl Med Mol Imaging. 2010;37:1452–61.

    Article  PubMed  Google Scholar 

  68. Mihaljevic AL, Rieger A, Belloni B, Hein R, Okur A, Scheidhauer K, et al. Transferring innovative freehand SPECT to the operating room: first experiences with sentinel lymph node biopsy in malignant melanoma. Eur J Surg Oncol. 2014;40:42–8.

    Article  CAS  PubMed  Google Scholar 

  69. Nieweg OE. Current status of sentinel lymph node biopsy in patients with melanoma. Rozhl Chir Mesicnik Cesk Chir Spol. 2014;93:485–90.

    CAS  Google Scholar 

  70. Eggermont AMM, Chiarion-Sileni V, Grob JJ, Dummer R, Wolchok JD, Schmidt H. Ipilimumab versus placebo after complete resection of stage III melanoma: initial efficacy and safety results from the EORTC 18071 phase III trial. J Clin Oncol. 2014;32:LBA9008.

    Google Scholar 

  71. Scolyer RA, Murali R, Satzger I, Thompson JF. The detection and significance of melanoma micrometastases in sentinel nodes. Surg Oncol. 2008;17:165–74.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Omgo E. Nieweg MD, PhD, FRACS & John F. Thompson MD, FRACS, FACS

  2. Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW, 2060, Australia

    Omgo E. Nieweg MD, PhD, FRACS & John F. Thompson MD, FRACS, FACS

  3. The Mater Hospital, North Sydney, NSW, Australia

    Omgo E. Nieweg MD, PhD, FRACS & John F. Thompson MD, FRACS, FACS

  4. Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Omgo E. Nieweg MD, PhD, FRACS & John F. Thompson MD, FRACS, FACS

  5. Sydney Medical School, The University of Sydney, Nuclear Medicine and Diagnostic Ultrasound, Suite 206, RPAH Medical Centre, 100 Carillon Ave., Newtown, NSW, Australia

    Roger F. Uren MD, FRACP, DDU

Authors
  1. Omgo E. Nieweg MD, PhD, FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roger F. Uren MD, FRACP, DDU
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John F. Thompson MD, FRACS, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Omgo E. Nieweg MD, PhD, FRACS .

Editor information

Editors and Affiliations

  1. Universitätsklinikum Würzburg, Department of Nuclear Medicine, Würzburg, Germany

    Ken Herrmann

  2. The University of Sydney, Melanoma Institute Australia, North Sydney, New South Wales, Australia

    Omgo E. Nieweg

  3. Arthur G. James Canc Hosp Richard J. Sol, The Ohio State Univ Comp Canc CTR, Columbus, Ohio, USA

    Stephen P. Povoski

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Nieweg, O.E., Uren, R.F., Thompson, J.F. (2016). Radioguided Sentinel Lymph Node Mapping and Biopsy in Cutaneous Melanoma. In: Herrmann, K., Nieweg, O., Povoski, S. (eds) Radioguided Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-26051-8_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-26051-8_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-26049-5

  • Online ISBN: 978-3-319-26051-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation