title: Tumor-positive sentinel node biopsy of the groin in clinically node-negative melanoma patients: superficial or superficial and deep lymph node dissection?
abstract: BACKGROUND
  The extent of a completion groin dissection in sentinel node-positive melanoma patients was guided by the location of the second-echelon nodes on the preoperative lymphoscintigram. The purposes of the current study were to investigate the pathological findings, the lymph node recurrences and (disease-free) survival associated with this approach.
  
  
  METHODS
  Between June 1996 and April 2007, 42 patients underwent completion groin dissection after a tumor-positive sentinel node biopsy. Eighteen patients had femoro-inguinal second-echelon nodes on their lymphoscintigram and underwent a superficial lymph node dissection. Twenty-four patients had iliac-obturator second-echelon nodes found by scan and underwent a combined superficial and deep dissection.
  
  
  RESULTS
  The median follow-up time was 61 months. One of the 18 patients who underwent a superficial groin dissection developed a deep (obturator) lymph node recurrence after 12 months. Revision of the lymphoscintigram showed that the images had been interpreted incorrectly and that the second-echelon node was located in the obturator area after all. A combined superficial and deep dissection revealed additional involved nodes in the deep lymph node compartment in 2 of the 24 patients. At 5 years, 77% of all patients were alive, and 56% were alive and free of disease. These figures were 76% and 53%, respectively, in the patients who underwent superficial dissection only, and 80% and 61%, respectively, in the patients who also underwent deep dissection.
  
  
  CONCLUSIONS
  This study suggests that a strategy to determine the extent of the groin dissection that is based on the location of the second-tier nodes may be valid.
authors.affiliation: Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam, 1066 CX, The Netherlands. i.vd.ploeg@nki.nl
authors.forename: Iris M C
authors.initials: IM
authors.lastname: van der Ploeg
authors.forename: Renato A
authors.initials: RA
authors.lastname: Valdés Olmos
authors.forename: Bin B R
authors.initials: BB
authors.lastname: Kroon
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006119:Groin / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D013671:Technetium Tc 99m Sulfur Colloid
chemical_list: D019275:Radiopharmaceuticals; D013671:Technetium Tc 99m Sulfur Colloid