Patterns of node mapping differ for axial and extremity primary cutaneous melanoma: A case for a more selective use of pre-operative imaging. Issue 4 (August 2016)

• Record Type: Journal Article
• Authors: Fitzgerald, Timothy L.; Gronet, Edward M.; Atluri, Prashanti; Zervos, Emmanuel E.; Wong, Jan H.
• Is Part Of: Surgeon. Volume 14:Issue 4(2016)
• Page Start: 190
• Page End: 195
• Publication Date: 2016-08
• Subjects: Melanoma -- Lymphoscintigraphy -- Sentinel lymph node -- Staging; Surgery -- Periodicals; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617
• DOI: 10.1016/j.surge.2014.10.004
• Languages: English
• ISSNs: 1479-666X

Abstract

Abstract: Purpose: Preoperative lymphoscintigraphy for sentinel lymph node mapping in melanoma improves the ability to locate nodes. However, it still remains unclear whether this step is required for all patients. Methods: Patients diagnosed with cutaneous melanoma from 1996 to 2012 were identified. Exclusion criteria were in situ disease, metastatic disease, or no SLN biopsy. Results: 214 patients were evaluated. Median age was 57 years, the majority were male (59.8%), white (97.2%), and stage I (60.7%). SLN revealed metastatic disease in 14.5% of patients. The most common primary site was the trunk (43.4%) followed by head and neck (21%), upper extremity (19.2%), and lower extremity (16.4%). Multiple lymphatic basins were most common for head and neck lesions (66.7%) followed by those on the trunk (28.8%), with fewer identified when lower (11.4%), and upper extremities were involved (4.2%). When comparison was restricted to extremity vs. axial, a single basin was noted in 94.5% vs. 59.9% of patients, p < 0.0001. For all extremity lesions the SLN was located in the primary basin. Additional sites included in-transit (popliteal) and second tier basins. The only melanomas with bilateral or contralateral SLN were axial melanomas. Conclusions: Patients with axial melanomas benefit most from lymphoscintigraphy. This step may not be required for extremity melanoma.