Darryl Schuitevoerder1, Stanley P L Leong2, Jonathan S Zager3, Richard L White4, Eli Avisar5, Heidi Kosiorek6, Amylou Dueck6, Jeanine Fortino7, Mohammed Kashani-Sabet2, Kyle Hart8, John T Vetto7. 1. Department of Surgery, Oregon Health & Science University, Portland, OR, USA. Electronic address: schuitev@ohsu.edu. 2. Center for Melanoma Research and Treatment, Department of Surgery, California Pacific Medical Center, San Francisco, CA, USA. 3. Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA. 4. Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Charlotte, NC, USA. 5. Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA. 6. Section of Biostatistics, Mayo Clinic Arizona, Phoenix, AZ, USA. 7. Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, OR, USA. 8. Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
Abstract
OBJECTIVE: There is currently no consensus regarding how to address pelvic sentinel lymph nodes (PSLNs) in melanoma. Thus, our objectives were to identify the incidence and clinical impact of PSLNs. METHODS: Retrospective review of a prospectively collected multi-institutional melanoma database. RESULTS: Of 2476 cases of lower extremity and trunk melanomas, 227 (9%) drained to PSLNs (181 to both PSLNs and superficial (inguinal or femoral) sentinel lymph nodes (SSLN) and 46 to PSLNs alone). Seventeen (7.5%) of 227 PSLN cases were positive for nodal metastasis, 8 of which drained to PSLNs only while 9 drained to both PSLNs and SSLNs. Complication rates between PSLN and SSLN biopsy were similar (15% vs. 14% respectively). In 181 cases with drainage to both SSLNs and PSLNs, PSLN biopsy upstaged one patient (0.6%), and completion dissection based on a positive PSLN did not upstage any. CONCLUSIONS: PSLN biopsy is safe, however in the setting of negative SSLNs there is minimal clinical impact. We therefore recommend PSLN biopsy when the SSLNs are positive or when the tumor drains to PSLNs alone.
OBJECTIVE: There is currently no consensus regarding how to address pelvic sentinel lymph nodes (PSLNs) in melanoma. Thus, our objectives were to identify the incidence and clinical impact of PSLNs. METHODS: Retrospective review of a prospectively collected multi-institutional melanoma database. RESULTS: Of 2476 cases of lower extremity and trunk melanomas, 227 (9%) drained to PSLNs (181 to both PSLNs and superficial (inguinal or femoral) sentinel lymph nodes (SSLN) and 46 to PSLNs alone). Seventeen (7.5%) of 227 PSLN cases were positive for nodal metastasis, 8 of which drained to PSLNs only while 9 drained to both PSLNs and SSLNs. Complication rates between PSLN and SSLN biopsy were similar (15% vs. 14% respectively). In 181 cases with drainage to both SSLNs and PSLNs, PSLN biopsy upstaged one patient (0.6%), and completion dissection based on a positive PSLN did not upstage any. CONCLUSIONS: PSLN biopsy is safe, however in the setting of negative SSLNs there is minimal clinical impact. We therefore recommend PSLN biopsy when the SSLNs are positive or when the tumor drains to PSLNs alone.
Authors: Mikko Vuoristo; Timo Muhonen; Virve Koljonen; Susanna Juteau; Micaela Hernberg; Suvi Ilmonen; Tiina Jahkola Journal: BJS Open Date: 2021-11-09