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Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node biopsy (SLNB) is routinely performed for primary cutaneous melanomas; however, limited data exist for SLNB after locally recurrent (LR) or in-transit (IT) melanoma.

Methods

Data from three centers performing SLNB for LR/IT melanoma (1997 to the present) were reviewed, with the aim of assessing (1) success rate; (2) SLNB positivity; and (3) prognostic value of SLNB in this population.

Results

The study cohort included 107 patients. Management of the primary melanoma included prior SLNB for 56 patients (52%), of whom 10 (18%) were positive and 12 had complete lymph node dissections (CLNDs). In the present study, SLNB was performed for IT disease (48/107, 45%) or LR melanoma (59/107, 55%). A sentinel lymph node (SLN) was removed in 96% (103/107) of cases. Nodes were not removed for four patients due to lymphoscintigraphy failures (2) or nodes not found during surgery (2). SLNB was positive in 41 patients (40%, 95% confidence interval (CI) 31.5–50.5), of whom 35 (88%) had CLND, with 13 (37%) having positive nonsentinel nodes. Median time to disease progression after LR/IT metastasis was 1.4 years (95% CI 0.75–2.0) for patients with a positive SLNB, and 5.9 years (95% CI 1.7–10.2) in SLNB-negative patients (p = 0.18). There was a trend towards improved overall survival for patients with a negative SLNB (p = 0.06).

Conclusion

SLNB can be successful in patients with LR/IT melanoma, even if prior SLNB was performed. In this population, the rates of SLNB positivity and nonsentinel node metastases were 40% and 37%, respectively. SLNB may guide management and prognosis after LR/IT disease.

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References

  1. 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(13):1307–17.

    Article  CAS  PubMed  Google Scholar 

  2. Faries MB, Thompson JF, Cochran A. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy trial. Ann Surg Oncol. 2010;17(12):3324–29.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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 micometastases. Ann Surg. 2003;238(4):538–49; ; discussion 549-50.

    PubMed  PubMed Central  Google Scholar 

  4. McMasters KM, Egger ME, Edwards MJ. Final results of the Sunbelt Melanoma Trial: a multi-institutional prospective randomized phase iii study evaluating the role of adjuvant high-dose interferon alfa-2b and completion lymph node dissection for patients staged by sentinel lymph node biopsy. J Clini Oncol. 2016;34(10):1079–86.

    Article  CAS  Google Scholar 

  5. Pawlik TW, Ross MI, Johnson MM, Schacherer CW, McClain DM, Mansfield PF et al. Predictors and natural history of in-transit melanoma after sentinel lymphadenectomy. Ann Surg Oncol. 2005;12(8):587–96.

    Article  PubMed  Google Scholar 

  6. Coit DG, Thompson JA, Andtbacka R, Anker CJ, Bichakjian CK, Carson WE, et al. Melanoma, version 4.2014. J Natl Compr Canc Netw. 2014;12:621–29.

    Article  CAS  PubMed  Google Scholar 

  7. Gershenwald JE, Scolyer RA, Hess KR. Melanoma of the skin. In: Alin MB, et al. editors. AJCC Cancer Staging Manual. 8th Ed. New York: Springer; 2017.

    Google Scholar 

  8. Read RL, Haydu L, Saw RP, Quinn MJ, Shannon K, Spillane AJ, et al. In-transit melanoma metastases: incidence, prognosis, and the role of lymphadenectomy. Ann Surg Oncol. 2015;22(2):475–81.

    Article  PubMed  Google Scholar 

  9. Gonzalez AB, Jakub JW, Harmsen WS. Status of the regional nodal basin remains highly prognostic in melanoma patients with in-transit disease. J Am Coll Surg. 2016;223(1):77–85.

    Article  PubMed  Google Scholar 

  10. Beasley GM, Speicher PJ, Sharma K, Seigler H, Salama A, Mosca P, et al. Efficacy of repeat sentinel lymph node biopsy for patients who develop recurrent melanoma. J Am Coll Surg. 2014;218(4):686–92.

    Article  PubMed  Google Scholar 

  11. Gipponi M, Solari N, Giovinazzo D, Queirolo P, Bertoglio S, Villa G, et al. The role of sentinel lymph node biopsy in patients with local recurrence or in-transit metastasis of melanoma. Anticancer Res. 2014;34(6):3197–03.

    PubMed  Google Scholar 

  12. Dewar DJ, Powel BWEM. Sentinel node biopsy in patients with in-transit recurrence of malignant melanoma. Br J Plast Surg. 2003;56:415–17.

    Article  CAS  PubMed  Google Scholar 

  13. Yao KA, Hsueh EC, Essner R, Foshag LJ, Wanek LA, Morton DL, et al. Is sentinel lymph node mapping indicated for isolated local and in-transit recurrent melanoma? Ann Surg. 2003;238(5):743–47.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hu Y, Melmer PD, Slingluff CL Jr. Localization of the sentinel lymph node in melanoma without blue dye. Ann Surg. 2016;262(3):588–92.

    Article  Google Scholar 

  15. McMasters KM, Reintgen DS, Ross MI. Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed? Ann Surg Oncol. 2001;8:192–97.

    Article  CAS  PubMed  Google Scholar 

  16. Harlow SP, Krag DN, Ashikaga T, Weaver DL, Meijer SJ, Loggie BW, et al. Gamma probe guided biopsy of the sentinel node in malignant melanoma: a multicentre study. Melanoma Res. 2001;11(1):45–55.

    Article  CAS  PubMed  Google Scholar 

  17. Morton DL, Cochran AJ, Thompson JF Sentinel node biopsy in melanoma [letter]. N Engl J Med. 2007;356:419–20.

    CAS  Google Scholar 

  18. 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;245:828–29.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Balch CM, Soong SI, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients. Validation of the AJCC melanoma staging system. J Clin Oncol. 2001;19(16):3635–48.

    Article  CAS  PubMed  Google Scholar 

  20. 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;248:378–386.

    PubMed  Google Scholar 

  21. Bass P, Schrafford Koops H, Haekstra H. Isolated regional perfusion in the treatment of melanoma of the extremities. Reg Cancer Treat. 1988;1:33–36.

    Google Scholar 

  22. Grünhagen DJ, Brunstein F, Graveland WJ, van Geel AN, de Wilt JH, Eggermont AM. One hundred consecutive isolated limb perfusions with TNF-alpha and melphalan in melanoma patients with multiple in-transit metastases. Ann Surg. 2004;240:939–47.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Noorda EM, Vrouenraets BC, Nieweg OE, van Geel BN, Eggermont AM, Kroon BB. Isolated limb perfusion for unresectable melanoma of the extremities. Arch Surg. 2004;139:1237–42.

    Article  PubMed  Google Scholar 

  24. Di Filippo F, Giacomini P, Rossi CR, Santinami M, Anza M, Garinei R, et al. Prognostic factors influencing tumor response, locoregional control and survival, in melanoma patients with multiple limb in-transit metastases treated with TNFα-based isolated limb perfusion. In Vivo. 2009;23:347–52.

    PubMed  Google Scholar 

  25. Morton DL. Overview and update of the phase III multicenter selective lymphadenectomy trials (MSLT-I and MSLT-II) in melanoma. Clin Exp Metastasis. 2012;29(7):699–06.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Morton DL, Thompson JF, Essner R, Elashoff R, Stern SL, Nieweg OE, et al. Validation of the accuracy of intraoperative lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: a multicenter trial. Multicenter Selective Lymphadenectomy Trial Group. Ann Surg. 1999;230(4):453–63; discussion 63–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Cochran AJ, Wen DR, Huang RR, Wang HJ, Elashoff R, Morton DL. Prediction of metastatic melanoma in nonsentinel nodes and clinical outcome based on the primary melanoma and the sentinel node. Mod Pathol. 2004; 17:747–55.

    Article  PubMed  Google Scholar 

  28. Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016; 17(6):757–67.

    Article  PubMed  Google Scholar 

  29. Eggermont AM, Chiarion-Sileni V, Grob JJ, Dummer R, Wolchok JD, Schmidt H, et al. Prolonged survival in stage III melanoma with ipilimumab adjuvant therapy. N Engl J Med. 2016;375:1845–55.

    Article  CAS  PubMed  Google Scholar 

  30. Grossmann KF, Othus M, Tarhini AA, et al. SWOG S1404: a phase III randomized trial comparing standard of care adjuvant therapy to pembrolizumab in patients with high risk resected melanoma [abstract no. e21032]. J Clin Oncol. 2016;34 Suppl

  31. Weber J, Grob JJ, Margolin KA, Ascierto PA, Sznol M, Ott PA, et al. A phase III study (CheckMate 238) of adjuvant immunotherapy with nivolumab (NIVO) versus ipilimumab (IPI) after complete resection of stage IIIb/c or stage IV melanoma (MEL) in patients (pts) at high risk for recurrence. J Immunother Cancer. 2015; 3(Suppl 2):P166.

    Article  PubMed Central  Google Scholar 

  32. Buzaid AC, Ross MI, Balch CM, Soong SJ, McCarthy WH, Tinoco L, et al. Critical analysis of the current American Joint Committee on cancer staging system for cutaneous melanoma and proposal of a new staging system. J Clin Oncol. 1997;15(3):1039–51.

    Article  CAS  PubMed  Google Scholar 

  33. Wrighston WR, Wong SL, Edwards MJ, Chao C, Reintgen DS, Ross MI, et al. Complications associated with sentinel lymph node biopsy for melanoma. Ann Surg Oncol. 2003;10(6):676–80.

    Article  Google Scholar 

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Funding

This study was supported in part by University of Virginia grant T32 CA163177 from the National Institutes of Health/National Cancer Institute (Yinin Hu).

Conflicts of interest

Georgia M. Beasley, Yinin Hu, Linda Youngwirth, Randall P. Scheri, April Salama, Kara Rossfeld, Syed Gardezi, Doreen Agnese, J. Harrison Howard, Douglas Tyler, Craig L. Slingluff Jr, and Alicia Terando have no conflicts of interest to declare.

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Authors and Affiliations

  1. Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH, USA

    Georgia M. Beasley MD, Kara Rossfeld MD, Doreen M. Agnese MD, J. Harrison Howard MD & Alicia M. Terando MD

  2. Division of Surgical Oncology, University of Virginia, Charlottesville, VA, USA

    Yinin Hu MD, Syed Gardezi MD & Craig L. Slingluff Jr MD

  3. Department of Surgery, Duke University, Durham, NC, USA

    Linda Youngwirth MD & Randall P. Scheri MD

  4. Division of Medical Oncology, Duke University, Durham, NC, USA

    April K. Salama MD

  5. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA

    Douglas S. Tyler MD

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  1. Georgia M. Beasley MD
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Correspondence to Georgia M. Beasley MD.

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Beasley, G.M., Hu, Y., Youngwirth, L. et al. Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study. Ann Surg Oncol 24, 2728–2733 (2017). https://doi.org/10.1245/s10434-017-5883-6

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  • DOI: https://doi.org/10.1245/s10434-017-5883-6

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