title: Efficacy of repeat sentinel lymph node biopsy in patients who develop recurrent melanoma.
abstract: BACKGROUND
  Even after negative sentinel lymph node biopsy (SLNB) for primary melanoma, patients who develop in-transit (IT) melanoma or local recurrences (LR) can have subclinical regional lymph node involvement.
  
  
  METHODS
  A prospective database identified 33 patients with IT melanoma/LR who underwent technetium 99m sulfur colloid lymphoscintigraphy alone (n = 15) or in conjunction with lymphazurin dye (n = 18) administered only if the IT melanoma/LR was concurrently excised.
  
  
  RESULTS
  Seventy-nine percent (26 of 33) of patients undergoing SLNB in this study had earlier removal of lymph nodes in the same lymph node basin as the expected drainage of the IT melanoma or LR at the time of diagnosis of their primary melanoma. Lymphoscintography at time of presentation with IT melanoma/LR was successful in 94% (31 of 33) cases, and at least 1 sentinel lymph node was found intraoperatively in 97% (30 of 31) cases. The SLNB was positive in 33% (10 of 30) of these cases. Completion lymph node dissection was performed in 90% (9 of 10) of patients. Nine patients with negative SLNB and IT melanoma underwent regional chemotherapy. Patients in this study with a positive sentinel lymph node at the time the IT/LR was mapped had a considerably shorter time to development of distant metastatic disease compared with those with negative sentinel lymph nodes.
  
  
  CONCLUSIONS
  In this study, we demonstrate the technical feasibility and clinical use of repeat SLNB for recurrent melanoma. Performing SLNB cannot only optimize local, regional, and systemic treatment strategies for patients with LR or IT melanoma, but also appears to provide important prognostic information.
authors: Division of Surgical Oncology, Duke University Medical Center, Durham, NC.
authors: Georgia M
authors: GM
authors: Beasley
authors: Division of Surgical Oncology, Duke University Medical Center, Durham, NC.
authors: Paul
authors: P
authors: Speicher
authors: Division of Surgical Oncology, Duke University Medical Center, Durham, NC.
authors: Ketan
authors: K
authors: Sharma
authors: Division of Surgical Oncology, Duke University Medical Center, Durham, NC.
authors: Hilliard
authors: H
authors: Seigler
authors: Department of Medicine, Duke University Medical Center, Durham, NC.
authors: April
authors: A
authors: Salama
authors: Division of Surgical Oncology, Duke University Medical Center, Durham, NC.
authors: Paul
authors: P
authors: Mosca
authors: Division of Surgical Oncology, Duke University Medical Center, Durham, NC. Electronic address: tyler002@acpub.duke.edu.
authors: Douglas S
authors: DS
authors: Tyler
mesh_terms: D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D061305:Lymphoscintigraphy; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery