Lymphoscintigraphy and sentinel node biopsy accurately stage melanoma in patients presenting after wide local excision.
BACKGROUND
Patients have traditionally been considered candidates for sentinel node biopsy (SNBx) only at the time of wide local excision (WLE). We hypothesized that patients with prior WLE may also be staged accurately with SNBx.


METHODS
Seventy-six patients, including 18 patients from the University of Virginia and 58 from a multicenter study of SNBx led by investigators at the University of Vermont, who had previous WLE for clinically localized melanoma underwent lymphoscintigraphy with SNBx. Median follow-up time was 38 months.


RESULTS
Intraoperative identification of at least 1 sentinel node was accomplished in 75 patients (98.6%). The mean number of sentinel nodes removed per patient was 2.0. Eleven patients (15%) had positive sentinel nodes. Among the 64 patients with negative SNBx, 3 (4%) developed nodal recurrences in a sentinel node-negative basin simultaneous with systemic metastasis, and 1 (1%) developed an isolated first recurrence in a lymph node.


CONCLUSIONS
This multicenter study more than doubles the published experience with SNBx after WLE and provides much-needed outcome data on recurrence after SNBx in these patients. These outcomes compare favorably with the reported literature for patients with SNBx at the time of WLE, suggesting that accurate staging of the regional lymph node bed is possible in patients after WLE.
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA. hle2r@virginia.edu
Heather L
HL
Evans
David N
DN
Krag
C David
CD
Teates
James W
JW
Patterson
Sybren
S
Meijer
Seth P
SP
Harlow
Kenneth K
KK
Tanabe
Brian W
BW
Loggie
Patrick W
PW
Whitworth
Roberto E
RE
Kusminsky
Ned Z
NZ
Carp
Michelle A
MA
Gadd
Craig L
CL
Slingluff
D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D013671:Technetium Tc 99m Sulfur Colloid
D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid