title: Delayed harvesting of sentinel lymph nodes after previous wide local excision of extremity melanoma.
abstract: BACKGROUND
  Harvesting the sentinel lymph node (SLN) is important in the management of patients with primary cutaneous melanoma. Selective sentinel lymphadenectomy (SSL) is generally performed at the time of wide local excision (WLE). The aim of our study was to determine whether delayed SSL is useful in detecting micrometastasis to the regional basin in patients with previous WLE of an extremity melanoma.
  
  
  METHODS
  Of 203 patients with a primary melanoma site located on the upper or lower extremity seen at the University of California, San Francisco/Mount Zion Melanoma Center from May 17, 1994, to March 23, 1999, 24 patients had a WLE of their extremity melanoma with adequate margins before referral. SSL was performed to assess micrometastasis in the regional lymph node basin after preoperative lymphoscintigraphy.
  
  
  RESULTS
  At least 1 SLN was identified in all 24 patients. At a median follow-up of 3 years, two patients showed micrometastasis in the SLNs. One of these two patients developed recurrence, and all remaining patients showed no evidence of disease.
  
  
  CONCLUSIONS
  Although it is generally advised that WLE should be performed simultaneously with SSL, delayed SSL after WLE of an extremity melanoma can still provide valuable staging information, which is critical for management of the patient.
authors.affiliation: Department of Surgery, Melanoma Center, University of California, San Francisco Medical Center at Mount Zion, San Francisco, California, USA. leongs@surgery.ucsf.edu
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
authors.forename: Marylou C
authors.initials: MC
authors.lastname: Thelmo
authors.forename: Robert P
authors.initials: RP
authors.lastname: Kim
authors.forename: Rahul
authors.initials: R
authors.lastname: Gokhale
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Rhee
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Achtem
authors.forename: Eugene
authors.initials: E
authors.lastname: Morita
authors.forename: Robert E
authors.initials: RE
authors.lastname: Allen
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashani-Sabet
authors.forename: Richard W
authors.initials: RW
authors.lastname: Sagebiel
mesh_terms: D000328:Adult; D000368:Aged; D005121:Extremities / Q000473:pathology*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery