Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of Lymphatic Mapping, Sentinel Lymphadenectomy, and Selective Complete Lymph Node Dissection as a Therapeutic Procedure for Early-Stage Melanoma

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

Abstract

Background: Lymphatic mapping, sentinel lymphadenectomy, and selective complete lymph node dissection (LM/SL/SCLND) is an increasingly popular alternative to elective lymphadenectomy (ELND) for patients with early-stage melanoma. Although several reports have demonstrated the accuracy of the LM/SL technique, there are no data on its therapeutic value.

Methods: We performed a matched-pair statistical analysis of 534 patients with clinical stage I melanoma; one half of the patients were treated with LM/SL and the other half were treated with ELND. Patients in the two treatment groups were matched for age (54% were ≤50 years of age), gender (63% were male patients), site of the primary melanoma (49% were on the extremities, 36% on the trunk, and 15% on the head and neck), and thickness of the primary melanoma (7% were <0.75 mm, 42% between 0.75 and 1.5 mm, 43% between 1.51 and 4.0 mm, and 8% >4 mm). Patients in the LM/SL group underwent complete regional lymphadenectomy (SCLND) only if the LM/SL specimen contained metastatic melanoma.

Results: The overall incidences of nodal metastases were no different (P = .18) between LM/SL (15.7%) and ELND (12%) groups, but the incidence of occult nodal disease was significantly (P = .025) higher among patients with intermediate-thickness (1.51–4.0-mm) primary tumors who underwent LM/SL (23.7%) instead of ELND (12.2%). Survival data were compared by the log-rank score test. LM/SL/SCLND and ELND resulted in equivalent 5-year rates of disease-free survival (79 ± 3.3% and 84 ± 2.2%, respectively; P = .25) and overall survival (88 ± 3.0% and 86 ± 2.1%, respectively; P = .98). The LM/SL and ELND groups also exhibited similar incidences of same-basin recurrences (4.8% vs. 2.1%, P = .10, respectively) and in-transit metastases (2.6% vs. 3.8%, P = .48) after tumor-negative dissections. Patients who underwent ELND showed a higher incidence of distant recurrences (8.9% vs. 4.0%, P = .03), but this may be related to the longer follow-up period for these patients (median, 169 months), compared with the LM/SL-treated patients (45 months). Among patients with tumor-positive nodal dissections, the 5-year overall survival rates were higher, and approached significance (P = .077) for patients treated by LM/SL/SCLND (64 ± 12%) compared with ELND (45 ± 10%).

Conclusions: These findings suggest that LM/SL/SCLND is therapeutically equivalent to ELND but may be more effective for identifying nodal metastases in patients with intermediate-thickness primary tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

REFERENCES

  1. Roses DF, Provet JA, Harris MN, Gumport SL, Dubin N. Prognosis of patients with pathologic stage II cutaneous malignant melanoma. Ann Surg 1985;201:103–107.

    CAS  PubMed  Google Scholar 

  2. Callery C, Cochran AJ, Roe DJ, et al. Factors prognostic for survival in patients with malignant melanoma spread to regional lymph nodes. Ann Surg 1982;196:69–75.

    CAS  PubMed  Google Scholar 

  3. Milton GW, Shaw HM, McCarthy WH, et al. Prophylactic lymph node dissection in clinical stage I cutaneous malignant melanoma: results of surgical treatment in 1319 patients. Br J Surg 1982;69:108–111.

    CAS  PubMed  Google Scholar 

  4. Balch CM, Soong SJ, Murad TM, Ingalls AL, Maddox WA. A multifactorial analysis of melanoma. II. Prognostic factors in patients with stage I (localized) melanoma. Surgery 1979;86:343–51.

    CAS  PubMed  Google Scholar 

  5. Balch CM. The role of elective lymph node dissection in melanoma:rationale, results, and controversies. J Clin Oncol 1988;6:163–172.

    CAS  PubMed  Google Scholar 

  6. Sim FH, Taylor WF, Ivins JC, Pritchard DJ, Soule EH. A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma: preliminary results. Cancer 1978;41:948–956.

    CAS  PubMed  Google Scholar 

  7. Veronesi U, Adamus J, Bandiera DC, et al. Inefficacy of immediate node dissection in stage I melanoma of the limbs. N Engl J Med 1977;297:627–630.

    Article  CAS  PubMed  Google Scholar 

  8. Veronesi U, Adamus J, Bandiera DC, et al. Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities. Cancer 1982;49:2420–2430.

    CAS  PubMed  Google Scholar 

  9. Balch CM, Soong S-J, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg 1996;224:255–266.

    CAS  PubMed  Google Scholar 

  10. Morton DL, Wen D-R, Cochran AJ, et al. Management of earlystage melanoma by intraoperative lymphatic mapping and selective lymphadenectomy: an alternative to routine elective lymphadenectomy or “watch and wait.” Surg Clin North Am 1992;1:247–259.

    Google Scholar 

  11. Morton DL, Wen D-R, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–399.

    CAS  PubMed  Google Scholar 

  12. Essner R. The role of lymphoscintigraphy and sentinel node mapping in assessing patient risk in melanoma. Semin Oncol 1997;24:S4–8–10.

    Google Scholar 

  13. Bostick P, Essner R, Sarantou T, et al. Intraoperative lymphatic mapping for early-stage melanoma of the head and neck. Am J Surg 1997;174:536–539.

    Article  CAS  PubMed  Google Scholar 

  14. Morton DL, Wen D-R, Foshag LJ, Essner R, Cochran A. Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck. J Clin Oncol 1993;11:1751–1756.

    CAS  PubMed  Google Scholar 

  15. Mantel N, Ciminera JL. Use of log-rank scores in the analysis of the litter-matched data on time to tumor appearance. Cancer Res 1979;39:4308–4315.

    CAS  PubMed  Google Scholar 

  16. Michalek JE, Mihalko D. On the use of log-rank scores in the analysis of litter-matched data on time to tumour appearance. Stat Med 1983;2:315–321.

    Article  CAS  PubMed  Google Scholar 

  17. Clark WHJr, Elder DE, Guerry DIV, et al. Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst 1989;81:1893–1904.

    PubMed  Google Scholar 

  18. Robinson DS, Sample WF, Fee HJ, et al. Regional lymphatic drainage in primary malignant melanoma of the trunk determined by colloidal gold scanning. Surg Forum 1977;28:147–148.

    CAS  PubMed  Google Scholar 

  19. Glass EC, Essner R, Morton DL. Kinetics of three lymphoscintigraphic agents in patients with cutaneous melanoma. J Nucl Med 1998;39:1185–1190.

    CAS  PubMed  Google Scholar 

  20. Cochran AJ, Wen D-R, Morton DL. Occult tumor cells in the lymph nodes of patients with pathological stage I malignant melanoma. Am J Surg Pathol 1988;12:612–618.

    Article  CAS  PubMed  Google Scholar 

  21. Bostick P, Essner R, Glass E, et al. Comparison of blue dye and probe assisted intraoperative lymphatic mapping in melanoma to identify sentinel nodes in 100 lymphatic basins. Arch Surg 1999;134:43–49.

    Article  CAS  PubMed  Google Scholar 

  22. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.

    Google Scholar 

  23. Cox DR. Regression model and life tables. J R Stat Soc Br 1972;34:187–220.

    Google Scholar 

  24. Rompel R, Garbe C, Buttner P, Teichelmann K, Petres J. Elective lymph node dissection in primary malignant melanoma: a matched-pair analysis. Melanoma Res 1995;5:189–194.

    CAS  PubMed  Google Scholar 

  25. Slingluff CL, Stidham KR, Ricci WM, Stanley WE, Seigler HF. Surgical management of regional lymph nodes in patients with melanoma: experience with 4682 patients. Ann Surg 1994;219:120–130.

    PubMed  Google Scholar 

  26. Sahin S, Rao B, Kopf AW, et al. Predicting ten-year survival of patients with primary cutaneous melanoma: corroboration of a prognostic model. Cancer 1997;80:1426–1431.

    CAS  PubMed  Google Scholar 

  27. Sappey MPC. Anatomie, physiologie, pathologie, des vaisseaux lymphatiques consideres chez l’Homme et les vertebres. Paris, A. DeLahaye and E. Lecrosnier, 1874.

  28. Norman J, Cruse CW, Wells K, et al. A redefinition of skin lymphatic drainage by lymphoscintigraphy for malignant melanoma. Am J Surg 1991;162:432–437.

    CAS  PubMed  Google Scholar 

  29. Alex JC, Krag DN. Gamma-probe guided localization of lymph nodes. Surg Oncol 1993;2:137–143.

    Article  CAS  PubMed  Google Scholar 

  30. Krag DN, Meijer SJ, Weaver DL, et al. Minimal-access surgery for staging of malignant melanoma. Arch Surg 1995;130:654–8.

    CAS  PubMed  Google Scholar 

  31. Miliotes G, Albertini J, Berman C, et al. The tumor biology of melanoma nodal metastases. Am Surg 1996;62:81–88.

    CAS  PubMed  Google Scholar 

  32. Thompson JF, McCarthy WH, Bosch CMJ, et al. Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes. Melanoma Res 1995;5:255–260.

    CAS  PubMed  Google Scholar 

  33. Reintgen D, Balch CM, Kirkwood J, Ross M. Recent advances in the care of the patient with malignant melanoma. Ann Surg 1997;225:1–14.

    CAS  PubMed  Google Scholar 

  34. Warso MA, Das Gupta TK. Melanoma recurrence in a previously dissected lymph node basin. Arch Surg 1994;129:252–255.

    CAS  PubMed  Google Scholar 

  35. Shaw JHF, Rumball EM. Complications and local recurrence following lymphadenectomy. Br J Surg 1990;77:760–764.

    CAS  PubMed  Google Scholar 

  36. Pijpers R, Collet GJ, Meijer S, Hoekstra OS. The impact of dynamic lymphoscintigraphy and gamma probe guidance on sentinel node biopsy in melanoma. Eur J Nucl Med 1995;22:1238–1241.

    CAS  PubMed  Google Scholar 

  37. Glass LF, Messina JL, Cruse W, et al. The use of intraoperative radiolymphoscintigraphy for sentinel node biopsy in patients with malignant melanoma. Dermatol Surg 1996;22:715–720.

    CAS  PubMed  Google Scholar 

  38. Reintgen D, Cruse CW, Wells K, et al. The orderly progression of melanoma nodal metastases. Ann Surg 1994;220:759–767.

    CAS  PubMed  Google Scholar 

  39. Leong SPL, Steinmetz I, Habib FA, et al. Optimal selective sentinel lymph node dissection in primary malignant melanoma. Arch Surg 1997;132:666–673.

    CAS  PubMed  Google Scholar 

  40. Essner R, Kuo CT, Wang H, et al. Prognostic implications of p53 overexpression in cutaneous melanoma from sun-exposed and nonexposed sites. Cancer 1998;82:309–316.

    CAS  PubMed  Google Scholar 

  41. Hoon DSB, Wang Y, Dale PS, et al. Detection of occult melanoma cells in blood with a multiple-marker polymerase chain reaction assay. J Clin Oncol 1995;13:2109–2116.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Roy E. Coats Research Laboratories of the John Wayne Cancer Institute, Santa Monica, California

    Richard Essner MD, Arnold Conforti MD, Mark C. Kelley MD, Leslie Wanek DrPH, Stacey Stern MS & Donald L. Morton MD

  2. Department of Nuclear Medicine, Saint John’s Health Center, Santa Monica, California

    Edwin Glass MD

  3. John Wayne Cancer Institute, 2200, Santa Monica Blvd., Santa Monica, CA, 90404

    Richard Essner MD

Authors
  1. Richard Essner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arnold Conforti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark C. Kelley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leslie Wanek DrPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stacey Stern MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edwin Glass MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Donald L. Morton MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by National Institutes of Health Grants CA12582 and CA29605 and by funding from the Wrather Family Foundation (Los Angeles, CA). Richard Essner, MD, is the recipient of an American Cancer Society Career Development Award.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Essner, R., Conforti, A., Kelley, M.C. et al. Efficacy of Lymphatic Mapping, Sentinel Lymphadenectomy, and Selective Complete Lymph Node Dissection as a Therapeutic Procedure for Early-Stage Melanoma. Ann Surg Oncol 6, 442–449 (1999). https://doi.org/10.1007/s10434-999-0442-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-999-0442-4

Key Words

Search

Navigation