A sentinel node biopsy does not increase the incidence of in-transit metastasis in patients with primary cutaneous melanoma.
BACKGROUND
It has been suggested that performing a sentinel node biopsy (SNB) in patients with cutaneous melanoma increases the incidence of in-transit metastasis (ITM).


METHODS
ITM rates for 2018 patients with primary melanomas > or =1.0 mm thick treated at a single institution between 1991 and 2000 according to 3 protocols were compared: wide local excision (WLE) only (n = 1035), WLE plus SNB (n = 754), and WLE plus elective lymph node dissection (n = 229).


RESULTS
The incidence of ITM for the three protocols was 4.9%, 3.6%, and 5.7%, respectively (not significant), and as a first site of recurrent disease the incidence was 2.5%, 2.4%, and 4.4%, respectively (not significant). The subset of patients who were node positive after SNB and after elective lymph node dissection also had similar ITM rates (10.8% and 7.1%, respectively; P = .11). On multivariate analysis, primary tumor thickness and patient age predicted ITM as a first recurrence, but type of treatment did not. Patients who underwent WLE only and who had a subsequent therapeutic lymph node dissection (n = 149) had an ITM rate of 24.2%, compared with 10.8% in patients with a tumor-positive sentinel node treated with immediate dissection (n = 102; P = .03).


CONCLUSIONS
Performing an SNB in patients with melanoma treated by WLE does not increase the incidence of ITM.
van Poll
Daan
D
Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia.
Thompson
John F
JF
Colman
Marjorie H
MH
McKinnon
J Gregory
JG
Saw
Robyn P M
RP
Stretch
Jonathan R
JR
Scolyer
Richard A
RA
Uren
Roger F
RF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009366:Neoplasm Seeding; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis