Sentinel lymph node biopsy for sebaceous cell carcinoma and melanoma of the ocular adnexa.
OBJECTIVE
To provide clinical details and long-term outcome data for a series of patients with eyelid or conjunctival melanoma or eyelid sebaceous cell carcinoma who underwent sentinel lymph node (SLN) biopsy.


METHODS
Retrospective interventional case series with review of clinical records and pathologic specimens.


METHODS
Tertiary comprehensive cancer center.


METHODS
Twenty-five consecutive patients treated at 1 institution for eyelid or conjunctival melanoma or eyelid sebaceous cell carcinoma from December 2000 to October 2004.


METHODS
Surgical removal of the eyelid or conjunctival tumor and SLN biopsy.


METHODS
Local treatment modalities; lymphatic basins in which SLNs were identified; status of SLNs; false-negative rate; and long-term patterns of local recurrence, regional and distant metastasis, and survival.


RESULTS
Seven patients had conjunctival melanoma, 8 had eyelid-margin melanoma with a considerable palpebral conjunctival component, and 10 had eyelid sebaceous cell carcinoma. The SLNs were identified in all but 1 patient by using technetium Tc 99m sulfur colloid as a tracer. Intraoperatively, in 16 patients in whom blue dye was used in addition to technetium Tc 99m sulfur colloid during mapping, no SLN was blue. One patient with conjunctival melanoma and 1 patient with eyelid melanoma had a histologically positive SLN. Two patients with eyelid melanoma and 2 patients with eyelid sebaceous cell carcinoma had negative findings from SLN biopsy but developed recurrence in their regional lymph nodes during the follow-up period. Overall, during follow-up, 2 of 10 patients with sebaceous cell carcinoma (20%) and 5 of 15 patients with eyelid or conjunctival melanoma (33%) had regional lymph node metastasis. Four patients with melanoma who had regional metastasis also developed distant organ metastasis. Two patients with sebaceous cell carcinoma--1 with regional metastasis and 1 without--developed distant organ metastasis.


CONCLUSIONS
The detection of histologically positive SLNs in this series of patients may justify further study of SLN biopsy for high-risk patients with ocular adnexal melanoma or eyelid sebaceous cell carcinoma. The false-negative rate is higher than that reported for SLN biopsy at most other anatomic sites. Patients with negative findings from SLN biopsy still require careful long-term follow-up because they may develop regional or distant metastasis.
Ho
Viet H
VH
Section of Ophthalmology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Ross
Merrick I
MI
Prieto
Victor G
VG
Khaleeq
Aisha
A
Kim
Stella
S
Esmaeli
Bita
B
D018266:Adenocarcinoma, Sebaceous / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005134:Eye Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012626:Sebaceous Gland Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D021701:Sentinel Lymph Node Biopsy / Q000379:methods