title: In-transit sentinel nodes must be found: implication from a 10-year follow-up study in melanoma.
abstract: The aim was to study the occurrence of in-transit nodes at a preoperative lymphoscintigraphy for patients with primary melanoma, and to reveal their potential role in prognosis. From 1984 to 1996, 911 patients, hospitalized for wide excision of a clinically localized primary cutaneous head-neck or truncal melanoma, had a static lymphoscintigraphy on the day before surgery as part of a prospective protocol. Lymph nodes were in no case removed at the time of scintigraphy. Recurrence and survival patterns were compared for patients with in-transit nodes with the remaining patients with only regional nodes. Follow-up time was a minimum of 10 years. In-transit nodes were visualized by lymphoscintigraphy in 6% of the patients, 18% of whom had a later recurrence in this region. The melanomas in the in-transit node group were slightly thicker, and ulceration was slightly more frequent (neither significant). The in-transit node group had significantly more lymph node basins visualized at scintigraphy compared with the remaining group of patients with only regional nodes. The risk of recurrence and/or death from melanoma was significantly worse (P<0.05) in the in-transit node group compared with the remaining patients. The clinical significance of the in-transit nodes, occasionally seen in melanoma patients (also in stage Ia), may suggest a slightly poorer prognosis and a substantial risk of a later recurrence in the in transit region. We therefore recommend that in-transit nodes must be found and examined exactly as is done with locoregional sentinel nodes.
authors.affiliation: Departments of Plastic Surgery and Burn Unit, Copenhagen University Hospital Rigshospitalet, Denmark. annette.hougaard.chakera@dadlnet.dk
authors.forename: Annette H
authors.initials: AH
authors.lastname: Chakera
authors.forename: Lone B
authors.initials: LB
authors.lastname: Hansen
authors.forename: Jørgen
authors.initials: J
authors.lastname: Lock-Andersen
authors.forename: Krzysztof T
authors.initials: KT
authors.lastname: Drzewiecki
authors.forename: Birger
authors.initials: B
authors.lastname: Hesse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000401:mortality