title: Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis of nonsentinel nodes following completion lymphadenectomy for melanoma.
abstract: BACKGROUND
  Most melanoma patients with sentinel lymph nodes (SLN) that are histologically positive for metastasis have no additional positive lymph nodes found upon completion lymph node dissection (CLND). Therefore, it has been suggested that CLND may not be required for all patients with positive SLN. This study was undertaken to determine the frequency with which nonsentinel nodes contain melanoma cells detected by RT-PCR.
  
  
  METHODS
  Negative control lymph nodes were obtained from patients with breast and colon cancer. Positive control lymph nodes contained histologic evidence of melanoma. Nonsentinel nodes were harvested from melanoma patients undergoing CLND for a positive SLN. RT-PCR analysis for melanoma markers tyrosinase, gp100, MART-1, and MAGE-3 was performed, with Southern blot detection. The RT-PCR test was considered positive for the presence of melanoma cells if tyrosinase and at least one other marker were detected above background levels.
  
  
  RESULTS
  RT-PCR analysis detected the presence of melanoma cells in 0/100 (0%) of negative control lymph nodes and 28/29 (97%) of positive control lymph nodes. A total of 117 histologically negative nonsentinel nodes from 13 patients who underwent CLND for positive SLN were evaluated. RT-PCR analysis was positive in 18/117 histologically negative nonsentinel nodes (15%) from 7/13 patients (54%).
  
  
  CONCLUSIONS
  RT-PCR analysis suggests that when the SLN contains histologic evidence of melanoma, the remaining nodes in that basin are at risk for metastatic disease, despite the fact that these nonsentinel nodes are infrequently histologically positive.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky 40202, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Wrightson
authors.forename: S L
authors.initials: SL
authors.lastname: Wong
authors.forename: M J
authors.initials: MJ
authors.lastname: Edwards
authors.forename: C
authors.initials: C
authors.lastname: Chao
authors.forename: A J
authors.initials: AJ
authors.lastname: Conrad
authors.forename: J
authors.initials: J
authors.lastname: Albrecht
authors.forename: V
authors.initials: V
authors.lastname: Viar
authors.forename: K M
authors.initials: KM
authors.lastname: McMasters
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology; D003110:Colonic Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D011184:Postoperative Period; D020133:Reverse Transcriptase Polymerase Chain Reaction