title: Routine biopsy of Cloquet's node is of limited value in sentinel node positive melanoma patients.
abstract: OBJECTIVE
  Biopsy of Cloquet's node (CN) during groin dissection has been used to indicate need for pelvic dissection. With earlier detection of microscopic regional disease in the era of sentinel node biopsy (SNB), frequency of positive CN may be so low that routine biopsy is unwarranted.
  
  
  METHODS
  Patients with positive groin SNB from 2000 to 2008 were identified from two centers. Cases where CN was identified at completion node dissection were selected. Lymphoscintigraphic, surgical, pathologic, and recurrence data were reviewed.
  
  
  RESULTS
  CN was identified in 53 cases. Median age was 44.5 years (range 7-77); median Breslow depth, 1.98 mm (range 0.5-25.0); % Clark's level IV/V, 90%; and % ulceration, 41.5%. Fifty (94.3%) underwent groin dissection alone; three others underwent concomitant pelvic dissection. Two (3.8%) patients had positive CN; both had additional indications for pelvic dissection. Delayed pelvic recurrence rate was 2/53 (3.8%); both patients had negative CN. In the three patients treated with concurrent groin and pelvic dissection, CN reflected pelvic nodal status in two cases; the third had pelvic metastases despite negative CN.
  
  
  CONCLUSIONS
  After positive SNB, disease involvement of CN is rare. Patients with positive biopsies of CN in the SNB era appear likely to have additional indications for pelvic dissection, minimizing utility of CN biopsy. Routine intraoperative sampling of CN may not be warranted during groin dissection for positive SNB.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine & The Winship Cancer Institute, Atlanta, Georgia, USA.
authors.forename: Carrie K
authors.initials: CK
authors.lastname: Chu
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
authors.forename: Suroosh S
authors.initials: SS
authors.lastname: Marzban
authors.forename: Mark I
authors.initials: MI
authors.lastname: Gimbel
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Murray
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Hestley
authors.forename: Jane L
authors.initials: JL
authors.lastname: Messina
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
authors.forename: Grant W
authors.initials: GW
authors.lastname: Carlson
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy