Interval sentinel lymph nodes in melanoma.
OBJECTIVE
For patients with melanoma, interval or in-transit sentinel lymph nodes (SLNs) have the same risk for nodal metastasis as SLN in traditional (ie, cervical, axillary, and inguinal) nodal basins.


METHODS
Prospective clinical trial.


METHODS
Multicenter study.


METHODS
Eligible patients were aged 18 to 70 years with melanomas of at least 1.0-mm Breslow thickness and nodes with clinically negative findings.


METHODS
Sentinel lymph node biopsy was guided by preoperative lymphoscintigraphy to identify all SLNs.


METHODS
We evaluated interval nodal sites, including epitrochlear, popliteal, and subcutaneous or intramuscular nodes outside of traditional basins, for the presence of metastases.


RESULTS
The SLNs were identified in 2332 nodal basins from 2000 patients. In 62 patients (3.1%), interval SLNs were identified. We found SLN metastases in 442 (19.5%) of 2270 conventional nodal basins and 13 (21.0%) of 62 interval sites. In 11 (84.6%) of the 13 cases in which we found an interval node that was positive for metastatic disease, it was the only site of nodal metastasis.


CONCLUSIONS
Although interval SLNs are identified infrequently, they contain metastatic disease at nearly the same frequency as SLNs in cervical, axillary, and inguinal nodal basins. Positive interval SLNs are likely to be the only site of nodal metastasis. Therefore, detailed preoperative lymphoscintigraphy and meticulous intraoperative search for interval nodes should be performed.
McMasters
Kelly M
KM
Division of Surgical Oncology, Department of Surgery, James Graham Brown Cancer Center, University of Louisvill, 529 S Jackson St, Louisville, KY 40202, USA. kelly.mcmasters@nortonhealthcare.org
Chao
Celia
C
Wong
Sandra L
SL
Wrightson
William R
WR
Ross
Merrick I
MI
Reintgen
Douglas S
DS
Noyes
R Dirk
RD
Cerrito
Patricia B
PB
Edwards
Michael J
MJ
D000328:Adult; D000368:Aged; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000473:pathology* / Q000556:secondary; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*