Current Treatment Options in Oncology

, Volume 13, Issue 3, pp 318–326 | Cite as

Surgical Treatment of Melanoma Patients with Early Sentinel Node Involvement

Skin Cancer (WH Sharfman, Section Editor)

Opinion statement

Sentinel lymph node biopsy (SLNB) is a standard staging procedure for many patients with clinically node negative, invasive melanoma, providing excellent prognostic information in appropriately selected patients. The broad acceptance of SLNB into clinical practice has resulted in substantial numbers of patients found to have microscopic nodal metastases. For patients with a positive sentinel node, a completion lymph node dissection (CLND) is the current standard of care. The majority of patients who undergo CLND are found to have histologically negative non-sentinel nodes, and yet are exposed to the potential morbidity of CLND, including infection, wound complications, and lymphedema. We do not yet know if there is a survival benefit from CLND that justifies its morbidity and we are currently unable to identify clinical and pathologic factors that may be associated with the likelihood of benefit from CLND. Controversy regarding the management of melanoma patients with a positive sentinel node highlights the need for continued investigation in melanoma biology, treatment, and outcomes. Patients with minimal tumor burden in their regional nodes would especially benefit from a better understanding of the appropriate management strategies. Ongoing clinical trials are aimed at determining whether CLND is superior to nodal observation and surveillance in patients with positive sentinel nodes, and at determining the outcome of patients with minimal disease in their sentinel node who forego CLND. These studies may help to resolve the uncertainties of the management in these patients. Until we have further information, CLND for melanoma patients with positive sentinel nodes remains the preferred, standard management strategy.

Keywords

melanoma sentinel node lymph node dissection 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA. A Cancer J Clin. 2012;62:10–29.CrossRefGoogle Scholar
  2. 2.
    Balch CM, Soong SJ, Gershenwald JE, et al. Prognostic factors analysis of 1600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol. 2001;19:3622–34.PubMedGoogle Scholar
  3. 3.
    White RR, Stanley WE, Johnson JJ, et al. Long-term survival in 2505 patients with melanoma with regional lymph node metastasis. Ann Surg. 2002;235:879–87.PubMedCrossRefGoogle Scholar
  4. 4.
    Snow H. Melanotic cancerous disease. Lancet. 1892;2:872–4.Google Scholar
  5. 5.
    Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Reintgen D, Cruse CW, Wells K, et al. The orderly progression of melanoma nodal metastases. Arch Surg. 1994;220:759–67.Google Scholar
  7. 7.
    Thompson JF, McCarthy WH, Bosch CM, et al. Sentinel lymph node status as an indicator of metastatic melanoma in regional lymph nodes. Melanoma Res. 1995;4:255–60.CrossRefGoogle Scholar
  8. 8.
    Van Akkooi A, Voit CA, Verhoef C, et al. New developments in sentinel node staging in melanoma: controversies and alternatives. Curr Opin Oncol. 2012;22:169–77.CrossRefGoogle Scholar
  9. 9.
    Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:130–17.PubMedCrossRefGoogle Scholar
  10. 10.•
    Coit DG, Andtbacka R, Anker CJ, et al. Melanoma. J Natl Compr Cancer Netw. 2012;10:366–400.Google Scholar
  11. 11.•
    Van der Ploeg A, van Akkooi A, Rutkowski P, et al. Prognosis in patients with sentinel-node positive melanoma is accurately defined by the combined Rotterdam tumor load and Dewar topography criteria. J Clin Oncol. 2011;29:2206–14.PubMedCrossRefGoogle Scholar
  12. 12.•
    McMasters KM, Noyes RD, Reintgen DS, et al. Lessons learned from the Sunbelt Melanoma Trial. J Clin Oncol. 2004;86:212–23.Google Scholar
  13. 13.
    Morton DL, Cochran AJ, Thompson JF, et al. Sentinel node biopsy for early stage melanoma: accuracy and morbidity in MSLT-1, an international multicenter trial. Ann Surg. 2005;242:202–313.Google Scholar
  14. 14.•
    Faries MB, Thompson JF, Cochran A, et al. The impact on morbidity and length of stay of early vs delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (1). Ann Surg Oncol. 2010;1:3324–29..CrossRefGoogle Scholar
  15. 15.
    McMasters KM, Wong SL, Edwards MJ, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol. 2002;9:137–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Gershenwald JE, Andtbacka R, Prieto VG, et al. Microscopic tumor burden in sentinel lymph nodes predicts synchronous nonsentinel lymph node involvement in patients with melanoma. J Clin Oncol. 2008;26:4296–303.PubMedCrossRefGoogle Scholar
  17. 17.•
    Murali R, Desilva C, Thompson JF, et al. Non-sentinel node risk score (N-SORE): a scoring system for accurately stratisfying risk of nonsentinel node positivity in patients with cutaneous melanoma with positive sentinel lymph nodes. J Clin Oncol. 2010;28:4441–9..PubMedCrossRefGoogle Scholar
  18. 18.
    Lee JH, Essner R, Torisu-Itakura H, et al. Factors predictive of tumor positive nonsentinel lymph node after tumor positive sentinel lymph node dissection for melanoma. J Clin Oncol. 2004;22:3677–84.PubMedCrossRefGoogle Scholar
  19. 19.
    Scolyer RA, Murali R, Satzger I, et al. The detection and significance of melanoma micrometastases in sentinel nodes. Surg Oncol. 2008;17:165–74.PubMedCrossRefGoogle Scholar
  20. 20.
    Van Akkooi A, Nowecki Z, Voit C, et al. Sentinel node tumor burden according to the Rotterdam criteria is the most important prognostic factor for survival in melanoma patients: a multicenter study in 388 patients with positive sentinel nodes. Ann Surg. 2008;248:949–55.PubMedCrossRefGoogle Scholar
  21. 21.
    Scheri RP, Essner R, Turner R, et al. Isolated tumor cells in the sentinel node affect long term prognosis of patients with melanoma. Ann Surg Oncol. 2007;14:2861–66.PubMedCrossRefGoogle Scholar
  22. 22.
    Murali R, DeSilva C, Mccarthy S, et al. Sentinel lymph nodes containing very small (<0.1 mm) deposits of metastatic melanoma cannot be safely regarded as tumor-negative. Ann Surg Oncol. 2012;19:1089–99.PubMedCrossRefGoogle Scholar
  23. 23.
    Scolyer RA, Murali R, Gershenwald JE, et al. Clinical relevance of melanoma micrometastases in sentinel nodes: too early to tell. Ann Surg Oncol. 2007;18:806–8.Google Scholar
  24. 24.
    Wong SL, Morton DL, Thompson JF, 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.PubMedCrossRefGoogle Scholar
  25. 25.
    Kingham PT, Panageas KS, Ariyan C, et al. Outcomes in patients with a positive sentinel lymph node who do not undergo completion lymphadenectomy. Ann Surg Oncol. 2010;17:514–20.PubMedCrossRefGoogle Scholar
  26. 26.
    Bilimoria KY, Balch CM, Bentrem DJ, et al. Complete lymph node dissection for sentinel node-positive melanoma: assessment of practice patterns in the United States. Ann Surg Oncol. 2008;15:1566–76.PubMedCrossRefGoogle Scholar
  27. 27.
    Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial. JAMA. 2011;305:569–75.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Johns Hopkins MedicineBaltimoreUSA

Personalised recommendations