Is skipped nodal metastasis a phenomenon of cutaneous melanoma?. (2021)

• Record Type: Journal Article
• Authors: El-Omar, Omar; Ragavan, Sharanniyan; Yoon, Won Young; Grant, Megan E.; Green, Adele C.; Oudit, Deemesh
• Is Part Of: Cancer treatment and research communications. Number 29(2021)
• Publication Date: 2021
• Subjects: Skipped nodal metastases -- Melanoma -- Sentinel node -- Lymphoscintigram
• DOI: 10.1016/j.ctarc.2021.100485
• Languages: English
• ISSNs: 2468-2942

Abstract

Highlights: Skipped nodal metastasis (SNM) is undocumented in cutaneous melanoma patients but of potential prognostic significance. SNM are highly unlikely to occur between regional nodal basins in cutaneous melanoma, and patients presenting with apparent first metastases to extra-regional nodal basins should be investigated for distant haematogenous metastases. Occurrence of SNM in cutaneous melanoma is highly unlikely. We recommend that patients presenting with extra-regional lymphadenopathy, without involvement of the regional nodal basin, should be investigated for distant haematogenous metastases. Abstract: Background and Methods: Skipped nodal metastasis (SNM) is a recognized phenomenon of visceral cancers when metastases bypass the regional basin and skip to a distant nodal basin without evidence of distant metastases. Its occurrence is undocumented in cutaneous melanoma patients but of potential prognostic significance. We therefore assessed the frequency of SNM in a large series of patients with limb melanomas. Patients and Methods: We studied melanoma patients attending a tertiary oncology hospital in northwest England using two approaches. First, we systematically searched medical records of an unselected patient sample treated 2002–2015, and second, we studied lymphoscintigrams of all patients with limb melanoma who underwent sentinel node biopsy 2008–2019. Results: Of 672 melanoma patients whose clinical records were examined, 16 had regional nodal metastases without apparent visceral spread and one appeared to have SNM but further scans were uncovered that showed concurrent pulmonary metastases. Of 667 limb melanoma patients with lymphoscintigrams, 7 showed dual lymphatic drainage patterns to distal as well as regional nodal basins, but none had micro-metastases solely in the distant basin. Conclusion: Occurrence of SNM in cutaneous melanoma is highly unlikely.