Abstract
Correct identification of the sentinel node (SN) and accurate evaluation of this node's tumor status constitute the most precise technique for staging clinically localized cutaneous melanoma. However, even if tumor is present in the SN (as in approximately 20% of patients), the remaining nodes in the basin are often tumor-free. We have found that the Breslow thickness of the primary, the relative area of tumor in the SN (with respect to the area of the SN), and the density of tendritic leukocytes in the SN paracortex not only can predict the likelihood of nonsentinel node metastases but also are correlated with likelihood of tumor recurrence and melanoma-specific survival. The most robust of these predictors is relative tumor area, and this may be used as the basis of practical predictive algorithms.
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Morton DL, Thompson JF, Essner R, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early stage melanoma: a multicenter trial.Ann Surg 1999;230:453–55.
Lucci A, Turner RR, Morton DL. Carbon dye as an adjunct to isosulfan blue dye for sentinel lymph node dissection.Surgery 1999;126:48–53.
Haigh PI, Lucci A, Turner RR, et al. Carbon dye histologically confirms the identity of sentinel nodes in cutaneous melanoma.Cancer 2001;92:535–41.
Morton DL, Hoon DSB, Cochran AJ, 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.
Cochran AJ, Pihl e, Wen D-R, et al. Zoned immune suppression of lymph nodes draining malignant melanoma: Histologic and immunohistologic studies.J Natl Cancer Inst 1987;78:399–405.
Huang RR, Wen D-R, Guo J, et al. Modulation of paracortical dendritic cells and T lymphocytes in breast cancer sentinel nodes.Breast J 2000;6:225–32.
Cochran AJ, Morton DL, Stern S, et al. Sentinel lymph nodes show profound downregulation of antigen-presenting cells of the paracortex: Implications for tumor biology and treatment,Mod Pathol 2001;14:604–8.
Lana A-M, Wen D-R, Cochran AJ. The morphology, immunophenotype and distribution of paracortical dendritic leukocytes in lymph nodes regional to cutaneous melanoma.Melanoma Res 2001;11:1–10
Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma.Arch Surg 1992;127:392–9.
Cochran AJ, Roberts AA, Saida T. The place of lymphatic mapping and sentinel node biopsy in oncology.Int J Clin Oncol 2003;8:139–50.
Cochran AJ. Surgical pathology remains pivotal in the evaluation of ‘sentinel’ lymph nodes.Am J Surg Pathol 1999;23:1169–72.
Singletary SE, Byers RM, Shallenberger R, et al. Prognostic factors in patients with regional cervical nodal metastases from cutaneous malignant melanoma.Am J Surg 1986;152:371–5.
Starz H, Balda BR, Kramer KU, et al. A micromorphometry-based concept for routine classification of sentinel lymph node metastases and its clinical relevance for patients with melanoma.Cancer 2001;91:2110–21.
Cochran AJ, Morton DL, Johnson TD, et al. Prediction of outcome and tumor-status of the non-sentinel node in melanoma patients with a positive sentinel node (abstract).Mod Pathol 2000;13:61.
Cook MG, Green MA, Anderson B, et al. The development of optimal pathological assessment of sentinel lymph nodes for melanoma.J Pathol 2003;200:314–9.
Cochran AJ, Wen D-R, Huang R-R, et al. Prediction of the presence of metastatic melanoma in non-sentinel nodes and of clinical outcome on the basis of characteristics of the primary melanoma and sentinel node.Mod Pathol (in press).
Cochran AJ, Lana AMA, Wen D-R. Histomorphometry in the assessment of prognosis in Stage II melanoma.Am J Surg Pathol 1989;13:600–4.
Wen D-R, Huang R-R, Starz H, et al. Prognostic factors predict nonsentinel node status in melanoma patients.Mod Pathol 2003;16:101A.
Cochran AJ, Morton DL, Stern S, et al. Sentinel lymph nodes show profound downregulation of antigen-presenting cells of the paracortex: Implications for tumor biology and treatment.Mod Pathol 2001;14:604–8.
Cochran AJ, Binder S, Remotti F. The role of microscopic evaluation in the management of cutaneous melanoma.Cancer Treat Res 1993;65:69–102.
Starz H, Haas CJ, Schulz GM, Balda BR. Tyrosinase RT-PCR as a supplement to histology for detecting melanoma and nevus cells in paraffin sections of sentinel lymph nodes.Mod Pathol 2003;16:920–9.
Wagner JD, Davidson D, Coleman JJ 3rd, et al. Lymph node tumor volumes in patients undergoing sentinel lymph node biopsy for cutaneous melanoma.Ann Surg Oncol 1999;6:398–404.
Ranieri JM, Wagner JD, Azuaje R, et al. Prognostic importance of lymph node tumor burden in melanoma patients staged by sentinel node biopsy.Ann Surg Oncol 2002;9:975–81.
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Cochran, A.J., Roberts, A., Wen, DR. et al. Optimized assessment of sentinel lymph nodes for metastatic melanoma: Implications for regional surgery and overall treatment planning. Annals of Surgical Oncology 11 (Suppl 3), 156S–161S (2004). https://doi.org/10.1007/BF02523621
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DOI: https://doi.org/10.1007/BF02523621