This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (11)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Skin Cancer  • Dermatology  • Melanoma  • Surgical Interventions, Other  • Alert me on articles by topic

Nahel Elias, MD; Kenneth K. Tanabe, MD; Arthur J. Sober, MD; Michele A. Gadd, MD; Martin C. Mihm, MD; Barrett Goodspeed, MS; A. Benedict Cosimi, MD

Arch Surg. 2004;139:400-405.

Hypothesis  Completion lymph node dissection (CLND) has usually been recommended after metastatic disease is identified in the sentinel lymph node (SLN) biopsy to eradicate further metastases in nonsentinel nodes. We hypothesized that patients with negative lymph nodes included in the initial SLN specimen have low risk of metastases in the residual draining basin and may not require CLND.

Design  Chart review.

Setting  University-affiliated tertiary care referral center.

Patients  Between January 1, 1997, and May 31, 2003, 506 consecutive patients underwent SLN biopsy for staging of primary cutaneous melanoma.

Intervention  The SLN biopsy identified 87 patients (17.2%) with metastatic melanoma, of whom 80 underwent CLND.

Results  In 28 patients, all SLNs were found to contain metastatic melanoma. Seven (25%) of these patients had additional metastases identified in the CLND specimen. In 52 patients, 1 or more SLNs did not contain metastatic melanoma. Five (10%) of these patients had additional metastases in the CLND specimen (P = .02).

Conclusions  Although no evidence of metastatic melanoma was found on CLND in most patients in whom negative nodes had been removed with positive SLNs at the initial biopsy, 10% of these patients did have further metastases. This subgroup of patients (positive SLNs and negative nodes in the SLN biopsy specimen) is at significantly lower risk for further metastasis, but CLND cannot be safely omitted even for these patients.

From the Departments of Surgery (Drs Elias, Tanabe, Gadd, and Cosimi), Dermatology (Dr Sober), and Pathology (Dr Mihm and Mr Goodspeed), Massachusetts General Hospital and Harvard Medical School, Boston.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Microscopic Tumor Burden in Sentinel Lymph Nodes Predicts Synchronous Nonsentinel Lymph Node Involvement in Patients With Melanoma
Gershenwald et al.
JCO 2008;26:4296-4303.
ABSTRACT | FULL TEXT  

Factors Predictive of Nonsentinel Lymph Node Involvement and Clinical Outcome in Melanoma Patients With Metastatic Sentinel Lymph Node
Rossi et al.
Ann. Surg. Oncol. 2008;15:1202-1210.
ABSTRACT | FULL TEXT  

Isolated Tumor Cells in the Sentinel Node Affect Long-Term Prognosis of Patients with Melanoma
Scheri et al.
Ann. Surg. Oncol. 2007;14:2861-2866.
ABSTRACT | FULL TEXT  

Intraoperative Evaluation of Sentinel Lymph Nodes for Metastatic Melanoma by Imprint Cytology
Soo et al.
Ann. Surg. Oncol. 2007;14:1612-1617.
ABSTRACT | FULL TEXT  

Histological Features of Melanoma Sentinel Lymph Node Metastases Associated with Status of the Completion Lymphadenectomy and Rate of Subsequent Relapse
Govindarajan et al.
Ann. Surg. Oncol. 2007;14:906-912.
ABSTRACT | FULL TEXT