Completion Lymph Node Dissection Might Be Avoided After Detecting a Single Sentinel Node Micrometastasis in Cutaneous Melanoma: Presented at ESSO

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Title: Completion Lymph Node Dissection Might Be Avoided After Detecting a Single Sentinel Node Micrometastasis in Cutaneous Melanoma: Presented at ESSO
URL: http://www.pslgroup.com/dg/22C5E2.htm
Doctor's Guide
September 15, 2008

By Shazia Qureshi

THE HAGUE, Netherlands -- September 15, 2008 -- Completion lymph node dissection (CLND) does not appear to be necessary in patients with cutaneous melanoma if even 1 micrometastasis is detected during sentinel lymph node biopsy, researchers reported here at the 14th Congress of the European Society of Surgical Oncology (ESSO).

Lead investigator Nebojša Glumac, MD, Department of Surgery, Institute of Oncology, Ljubljana, Slovenia, presented the results of this retrospective study on September 12. She noted, "Iliac CLND was not beneficial after detecting a single macrometastasis or any micrometastases in inguinal sentinel nodes."

Dr. Glumac and colleagues performed sentinel lymph node biopsies in 728 patients with stage I or II cutaneous melanoma between 2001 and 2007. The researchers defined micrometastasis for this study as a metastasis smaller than 2 mm in diameter.

Biopsies were positive for the presence of tumour cells in the inguinal region in 54 patients and bilaterally in 1 patient. Subsequently, 17 of these patients underwent inguinal-iliac CLND and 38 underwent inguinal CLND. These patients were a median of 55 years old and 45% of them were men.

Results CLND identified 11 patients with metastases, including 4 patients who underwent inguinal-iliac CLND and 7 who underwent inguinal CLND. During follow-up, systemic metastasis was not found in any of the 7 patients who underwent inguinal CLND.

Metastases to iliac nodes were seen in 2 patients. One patient had multiple infiltrative metastases in 2 sentinel nodes. One patient had 1 non-sentinel micrometastasis in an iliac node and multiple metastases in 2 sentinel lymph nodes. The researchers suspected that this patient already had systemic disease at the time of the CLND because systemic metastases appeared within weeks after the CLND procedure, Dr. Glumac said.

Regardless of the type of CLND performed, only those patients who had multiple infiltrative macrometastases to the sentinel nodes had more than 2 additional non-sentinel positive nodes, the investigators found. None of the 13 patients with 1 micrometastasis to sentinel nodes showed additional metastases in non-sentinel nodes.

[Presentation title: Inguinal or Inguino-Iliac Lymph Node Dissection After Positive Inguinal Sentinel Lymph Node in Patients with Cutaneous Melanoma. Abstract 179]

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