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Prognostic Significance and Management of Sentinel Nodes in the Triangular Intermuscular Space of Patients with Melanoma

  • Melanoma
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Abstract

Background

The clinical significance of sentinel nodes (SNs) in the triangular intermuscular space (TIS) of patients with melanoma is poorly understood. This study aimed to determine their incidence and positivity rate, and to report their management and patient outcomes.

Methods

This was a single-institution retrospective cohort study of patients with unilateral or bilateral TIS SNs on lymphoscintigraphy treated between 1992 and 2017. Recurrence-free survival was analyzed.

Results

Lymphoscintigraphy identified TIS SNs in 266 patients. They were bilateral in 17 patients. Of the 2296 patients with a melanoma on the upper back, 259 (11%) had TIS SNs. Procurement of SNs was not attempted in 122 (43%) of the 283 cases and failed in 11 cases (7%). An SN was successfully retrieved from the TIS in 145 patients (53%) and contained metastasis in 18 of 150 TIS SNs. This was the only positive SN in 12 patients (8%), upstaging all of them. Of the 18 patients with a positive SN in the TIS, 9 (50%) underwent completion axillary lymph node dissection, but no additional involved nodes were found in any of these patients. Recurrence in the TIS was observed in six patients (5%), none of whom had their TIS SN surgically pursued previously.

Conclusions

Lymphoscintigraphy showed TIS SNs in 11% of patients with melanomas on their upper back. In such cases, retrieval of TIS SNs is required for accurate staging and to minimize the risk of TIS recurrence.

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Acknowledgment

This study was funded by the Danish Cancer Society, Reinholdt W. Jorck og Hustrus Fond, and Knud Højgaard Fonden. We thank Melanoma Institute Australia and Alfred Nuclear Medicine and Ultrasound, Sydney, Australia for facilitating this study by providing staff assistance and resources. Special thanks go to Hazel Bourke, who undertook data extraction from the institutional database and to Kaye Oakley, Martin Drummond, and Kim Ioannou for their assistance.

Funding

Kræftens Bekæmpelse, Reinholdt W. Jorck og Hustrus Fond, Knud Højgaard Fonden, Melanoma Institute Australia.

Author information

Author notes

  1. Annette H. Chakera and Omgo E. Nieweg have contributed equally to this work.

Authors and Affiliations

  1. Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, North Sydney, NSW, 2060, Australia

    Trine Schoenfeldt MD, John F. Thompson MD, FRACS, FACS, Serigne Lo MSc, PhD, Jonathan Stretch MBBS, DPhil(Oxon), FRACS, Robyn P. M. Saw MBBS, MS, FRACS, Andrew Spillane MD, FRACS, Kerwin Shannon MBBS, FRACS, Roger F. Uren MD, FRACP, DDU & Omgo E. Nieweg MD, PhD, FRACS

  2. Leo Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark

    Trine Schoenfeldt MD

  3. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson MD, FRACS, FACS, Jonathan Stretch MBBS, DPhil(Oxon), FRACS, Robyn P. M. Saw MBBS, MS, FRACS, Andrew Spillane MD, FRACS, Kerwin Shannon MBBS, FRACS, Roger F. Uren MD, FRACP, DDU & Omgo E. Nieweg MD, PhD, FRACS

  4. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    John F. Thompson MD, FRACS, FACS, Jonathan Stretch MBBS, DPhil(Oxon), FRACS, Robyn P. M. Saw MBBS, MS, FRACS, Kerwin Shannon MBBS, FRACS & Omgo E. Nieweg MD, PhD, FRACS

  5. Department of Plastic Surgery, Breast Surgery and Burns, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark

    Krzysztof T. Drzewiecki MD, PhD

  6. Department of Clinical Medicine, The University of Copenhagen, Copenhagen, Denmark

    Krzysztof T. Drzewiecki MD, PhD

  7. Breast and Melanoma Surgery Unit, Royal North Shore Hospital, St Leonards, Sydney, Australia

    Andrew Spillane MD, FRACS

  8. Alfred Nuclear Medicine and Ultrasound, Sydney, NSW, Australia

    Roger F. Uren MD, FRACP, DDU

  9. Department of Plastic Surgery, Copenhagen University Hospital – Herlev and Gentofte, Copenhagen, Denmark

    Annette H. Chakera MD, PhD

Authors
  1. Trine Schoenfeldt MD
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  2. John F. Thompson MD, FRACS, FACS
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  3. Serigne Lo MSc, PhD
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  4. Krzysztof T. Drzewiecki MD, PhD
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  5. Jonathan Stretch MBBS, DPhil(Oxon), FRACS
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  6. Robyn P. M. Saw MBBS, MS, FRACS
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  7. Andrew Spillane MD, FRACS
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  8. Kerwin Shannon MBBS, FRACS
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  9. Roger F. Uren MD, FRACP, DDU
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  10. Annette H. Chakera MD, PhD
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  11. Omgo E. Nieweg MD, PhD, FRACS
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Corresponding author

Correspondence to John F. Thompson MD, FRACS, FACS.

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Disclosures

John F. Thompson has received honoraria for advisory board participation from BMS Australia, MSD Australia, GSK, and Provectus Inc, as well as travel and conference support from GSK, Provectus Inc, and Novartis. Robyn P. M. Saw has received honoraria for advisory board participation from MSD, Novartis, and Qbiotics and speaking honoraria from BMS and Novartis. The remaining authors have no conflicts of interest.

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Schoenfeldt, T., Thompson, J.F., Lo, S. et al. Prognostic Significance and Management of Sentinel Nodes in the Triangular Intermuscular Space of Patients with Melanoma. Ann Surg Oncol 30, 2354–2361 (2023). https://doi.org/10.1245/s10434-022-12840-2

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