title: Diagnosis and treatment of interval sentinel lymph nodes in patients with cutaneous melanoma.
abstract: BACKGROUND
  Interval sentinel lymph nodes in patients with melanoma are occasionally found outside conventional nodal basins. In this study, the authors examined the frequency, location, and incidence of nodal metastasis of such interval nodes in a large cohort of patients with primary cutaneous melanoma.
  
  
  METHODS
  Between September of 1997 and February of 2003, 374 consecutive patients at the Yale Cancer Center Melanoma Unit underwent sentinel lymph node biopsy for primary cutaneous melanoma with a Breslow thickness of at least 1.0 mm and/or Clark IV or greater histologic dermal invasion. All patients underwent preoperative lymphoscintigraphy to map the lymphatic drainage for the primary lesion and intraoperative confirmation, and biopsy was performed on all sentinel lymph nodes identified.
  
  
  RESULTS
  Unequivocal interval sentinel lymph nodes were identified in eight of 374 patients (2.1 percent). Three of these eight patients had metastatic spread to the interval sentinel nodes. In four of the eight patients, the interval sentinel lymph node was not located in the anticipated lymphatic pathway between the primary tumor and the sentinel lymph node basin.
  
  
  CONCLUSIONS
  Interval sentinel nodes seem as likely to contain micrometastatic disease as those in the expected sentinel lymph node basin. Half of the subjects displayed interval sentinel lymph nodes that were not in the anticipated lymphatic pathway between the primary tumor and the sentinel lymph node basin. These findings suggest that adequate preoperative lymphoscintigraphy and intraoperative recognition of interval nodes are of paramount importance in the treatment of melanoma.
authors.affiliation: Department of Surgery and the Yale Cancer Center Melanoma Unit, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Tobias
authors.initials: T
authors.lastname: Carling
authors.forename: Deborah
authors.initials: D
authors.lastname: Pan
authors.forename: Stephan
authors.initials: S
authors.lastname: Ariyan
authors.forename: Deepak
authors.initials: D
authors.lastname: Narayan
authors.forename: Carolyn
authors.initials: C
authors.lastname: Truini
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology* / Q000556:secondary