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Selective Sentinel Lymph Node Dissection for Melanoma: Importance of Harvesting Nodes with Lower Radioactive Counts without the Need for Blue Dye

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

Abstract

Background

Determining how many sentinel lymph nodes (SLNs) should be removed for melanoma is important. The purpose of this study is to determine the frequency at which nodes that are less radioactive than the “hottest” node (which is negative) are positive for melanoma, how low of a radioactivity should warrant harvest, and if isosulfan blue is necessary.

Methods

We reviewed 1,152 melanoma patients who underwent lymphoscintigraphy with technetium, with or without blue dye, and SLN dissection from 1996 to 2008. SLNs with radioactivity ≥10% of the “hottest” SLN, all blue nodes, and all suspicious nodes were removed and analyzed. The miss rate was calculated as the proportion of node positive cases in which the “hottest” SLN was negative.

Results

SLNs were identified in 1,520 nodal basins in 1,152 patients. SLN micrometastases were detected in 218 basins (14%) in 204 patients (18%). In 16% of SLN-positive patients (33/204 patients), the positive SLN was found to have a lower radioactive count than the “hottest” SLN, which was negative. In 21 of these cases, the positive SLNs had radioactivity ≤50% of the “hottest” SLN. The 10% rule significantly reduced the miss rate to 2.5% compared with removal of only the “hottest” SLN (miss rate = 16%). Also, blue dye did not significantly decrease the miss rate compared with radiocolloid alone using the 10% rule.

Conclusions

To decrease the miss rate, all SLNs with ≥10% of the ex vivo radioactivity of the “hottest” SLN should be removed and blue dye is not essential.

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Conflicts of interest

We have no commercial interests or sources of any financial or material support to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of California, San Francisco, CA, USA

    Liang-Chih Liu MD, Tyler Jenkins BA, Wayne Lee MD, Laura Huang BS, Robert E. Allen MD & Stanley P. L. Leong MD

  2. The Buncke Clinic, Division of Plastic Surgery, California Pacific Medical Center, San Francisco, CA, USA

    Brian M. Parrett MD

  3. Department of Nuclear Medicine, University of California, San Francisco, CA, USA

    Eugene Morita MD

  4. Department of Pathology, University of California, San Francisco, CA, USA

    Patrick Treseler MD

  5. Department of Dermatology, University of California, San Francisco, CA, USA

    Suresh Thummala MD & Mohammed Kashani-Sabet MD

  6. Center for Melanoma Research & Treatment, California Pacific Medical Center & Research Institute, San Francisco, CA, USA

    Suresh Thummala MD, Mohammed Kashani-Sabet MD & Stanley P. L. Leong MD

Authors
  1. Liang-Chih Liu MD
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  2. Brian M. Parrett MD
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  3. Tyler Jenkins BA
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  4. Wayne Lee MD
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  5. Eugene Morita MD
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  6. Patrick Treseler MD
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  7. Laura Huang BS
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  8. Suresh Thummala MD
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  9. Robert E. Allen MD
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  10. Mohammed Kashani-Sabet MD
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  11. Stanley P. L. Leong MD
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Correspondence to Stanley P. L. Leong MD.

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Liu, LC., Parrett, B.M., Jenkins, T. et al. Selective Sentinel Lymph Node Dissection for Melanoma: Importance of Harvesting Nodes with Lower Radioactive Counts without the Need for Blue Dye. Ann Surg Oncol 18, 2919–2924 (2011). https://doi.org/10.1245/s10434-011-1689-0

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  • DOI: https://doi.org/10.1245/s10434-011-1689-0

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