Annals of Surgical Oncology

, Volume 18, Issue 12, pp 3309–3315 | Cite as

Inguinopelvic Lymphadenectomy Following Positive Inguinal Sentinel Lymph Node Biopsy in Melanoma: True Frequency of Synchronous Pelvic Metastases

  • Carrie K. Chu
  • Keith A. Delman
  • Grant W. Carlson
  • Andrea C. Hestley
  • Douglas R. Murray
Melanomas

Abstract

Background

True frequency of synchronous pelvic metastases with positive inguinal sentinel lymph node (SLN) biopsy is unknown. Role of pelvic dissection in the SLN era is unclear.

Methods

From 1994 to 2004, 1 surgeon routinely performed nonselective, complete inguinopelvic lymphadenectomy after positive inguinal SLN biopsy. All cases were identified from a prospectively maintained database. Clinicopathologic features associated with pelvic disease were assessed.

Results

A total of 40 patients with positive inguinal SLN underwent, without additional selection, 42 complete inguinopelvic lymphadenectomies. Median age was 46.5 years (range 25–79 years); 79% had lower extremity primaries. Median Breslow depth was 2.3 mm (range 1.0–10.0 mm), Clark’s IV/V 98%, ulceration 26%. Frequency of synchronous pelvic disease upon completion lymphadenectomy was 5 of 42 (11.9%). Patients with and without pelvic disease were similar in age, sex, Breslow depth, Clark’s level, ulceration, and mitoses. All 5 cases with pelvic metastases had extremity primaries (4 distal, 1 proximal). Of the 5, 3 (60%) had ≥3 total involved inguinal nodes, compared with only 1 (2.7%) of the 37 cases without pelvic disease (P = .003). Ratio of positive to total number inguinal nodes retrieved was >0.20 in 80% of cases with pelvic disease and 8.6% of cases without (P = .002). Upon lymphoscintigraphy review, secondary pelvic drainage was present in 80% of cases with pelvic disease compared with 56% of cases without pelvic disease, though the trend was statistically insignificant (P = .63).

Conclusions

In this cohort of unselected, SLN-positive patients with complete inguinopelvic lymphadenectomy, frequency of synchronous pelvic disease was 11.9%. Patients with ≥3 total involved inguinal nodes or inguinal node ratio >0.20 appear more likely to harbor pelvic disease.

References

  1. 1.
    Morton DL, Cochran AJ, Thompson JF, Elashoff R, Essner R, Glass EC, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005;242:302–11; discussion 311–3.PubMedGoogle Scholar
  2. 2.
    Carlson GW, Page AJ, Cohen C, Parker D, Yaar R, Li A, et al. Regional recurrence after negative sentinel lymph node biopsy for melanoma. Ann Surg. 2008;248:378–86.PubMedGoogle Scholar
  3. 3.
    Sabel MS, Griffith K, Sondak VK, Lowe L, Schwartz JL, Cimmino VM, et al. Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg. 2005;201:37–47.PubMedCrossRefGoogle Scholar
  4. 4.
    McMasters KM, Wong SL, Edwards MJ, Chao C, Ross MI, Noyes RD, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol. 2002;9:137–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Lee JH, Essner R, Torisu-Itakura H, Wanek L, Wang H, Morton DL. Factors predictive of tumor-positive nonsentinel lymph nodes after tumor-positive sentinel lymph node dissection for melanoma. J Clin Oncol. 2004;22:3677–84.PubMedCrossRefGoogle Scholar
  6. 6.
    Page AJ, Carlson GW, Delman KA, Murray D, Hestley A, Cohen C. Prediction of nonsentinel lymph node involvement in patients with a positive sentinel lymph node in malignant melanoma. Am Surg. 2007;73:674–8; discussion 78–9.PubMedGoogle Scholar
  7. 7.
    Coit DG, Brennan MF. Extent of lymph node dissection in melanoma of the trunk or lower extremity. Arch Surg. 1989;124:162–6.PubMedGoogle Scholar
  8. 8.
    Mann GB, Coit DG. Does the extent of operation influence the prognosis in patients with melanoma metastatic to inguinal nodes? Ann Surg Oncol. 1999;6:263–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Badgwell B, Xing Y, Gershenwald JE, Lee JE, Mansfield PF, Ross MI, et al. Pelvic lymph node dissection is beneficial in subsets of patients with node-positive melanoma. Ann Surg Oncol. 2007;14:2867–75.PubMedCrossRefGoogle Scholar
  10. 10.
    Jacobs LK, Balch CM, Coit DG. Inguinofemoral, iliac/obturator, and popliteal lymphadenectomy in patients with melanoma. In: Balch CM, Houghton AN, Sober AJ, Soong S, Atkins MB, Thompson JF, editors. Cutaneous melanoma. St. Louis: Quality Medical Publishing, 2009. p. 457–70.Google Scholar
  11. 11.
    Strobbe LJ, Jonk A, Hart AA, Nieweg OE, Kroon BB. Positive iliac and obturator nodes in melanoma: survival and prognostic factors. Ann Surg Oncol. 1999;6:255–62.PubMedCrossRefGoogle Scholar
  12. 12.
    Murray DR, Carlson GW, Greenlee R, Alazraki N, Fry-Spray C, Hestley A, et al. Surgical management of malignant melanoma using dynamic lymphoscintigraphy and gamma probe-guided sentinel lymph node biopsy: the Emory experience. Am Surg. 2000;66:763–7.PubMedGoogle Scholar
  13. 13.
    Karakousis CP, Driscoll DL, Rose B, Walsh DL. Groin dissection in malignant melanoma. Ann Surg Oncol. 1994;1:271–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Hughes TM, Thomas JM. Combined inguinal and pelvic lymph node dissection for stage III melanoma. Br J Surg. 1999;86:1493–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Essner R, Scheri R, Kavanagh M, Torisu-Itakura H, Wanek LA, Morton DL. Surgical management of the groin lymph nodes in melanoma in the era of sentinel lymph node dissection. Arch Surg. 2006;141:877–82; discussion 882–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Santinami M, Carbone A, Crippa F, Maurichi A, Pellitteri C, Ruggeri R, et al. Radical dissection after positive groin sentinel biopsy in melanoma patients: rate of further positive nodes. Melanoma Res. 2009;19:112–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Xing Y, Badgwell BD, Ross MI, Gershenwald JE, Lee JE, Mansfield PF, et al. Lymph node ratio predicts disease-specific survival in melanoma patients. Cancer. 2009;115:2505–13.PubMedCrossRefGoogle Scholar
  18. 18.
    van der Ploeg IM, Valdes Olmos RA, Kroon BB, Nieweg OE. Tumor-positive sentinel node biopsy of the groin in clinically node-negative melanoma patients: superficial or superficial and deep lymph node dissection? Ann Surg Oncol. 2008;15:1485–91.PubMedCrossRefGoogle Scholar
  19. 19.
    van der Ploeg IM, Kroon BB, Valdes Olmos RA, Nieweg OE. Evaluation of lymphatic drainage patterns to the groin and implications for the extent of groin dissection in melanoma patients. Ann Surg Oncol. 2009;16:2994–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Carrie K. Chu
    • 1
  • Keith A. Delman
    • 1
  • Grant W. Carlson
    • 1
  • Andrea C. Hestley
    • 1
  • Douglas R. Murray
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryEmory University School of Medicine & The Winship Cancer InstituteAtlantaUSA

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