title: The role of sentinel lymph node biopsy in patients with local recurrence or in-transit metastasis of melanoma.
abstract: From January 2003 to March 2010, a prospective study was undertaken at the National Cancer Research Institute of Genoa in 15 patients with melanoma who had local recurrence (LR) or a few (≤ 3) in-transit metastases and clinically-negative regional lymph nodes with the aim of defining: i) the feasibility of sentinel node re-staging (r-sN) of the regional nodal basin; ii) the prognostic value of sentinel node status, and iii) the potential benefit in terms of disease-free survival and overall survival in patients with an histologically-positive sentinel node undergoing therapeutic regional lymph node dissection. Preoperative lymphoscintigraphy was performed to identify the r-sN: the radiotracer was intra-dermally injected around the LR or in-transit metastasis. Moreover, 10 min prior to the operative procedure, 0.5 ml intradermal injection of Patent-Blue-V dye was given around each LR or in-transit metastasis site, so that r-sN identification was achieved by both visualization of the nodal blue dye staining and the information supplied by gamma-detection probe. At least one sentinel node was intra-operatively identified in each patient, and a tumor-positive r-sN was required in four out of fifteen patients. The interval between the diagnosis of primary melanoma and the onset of recurrence was longer, although not significantly, in patients with tumor-negative r-sN, a compared to tumor-positive r-sN (49 ± 47 months vs. 25 ± 19 months, p=0.342). There was a trend toward an improved 1-, 3-, and 5-year disease-free survival and overall survival in patients with tumor-negative r-sN a compared to tumor-positive r-sN. Hence, the r-sN proved to be a feasible and accurate staging procedure even in patients with a few localizations of LR or in-transit metastases (≤ 3). r-sN identified those with a more favorable prognosis, supporting an aggressive therapeutic approach in the natural history of their disease; moreover, an unnecessary regional lymph node dissection was safely avoided in 11 out of 15 73.3% patients because they had a tumor-negative r-sN.
authors.affiliation: Division of Surgery, Breast Unit, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy marco.gipponi@hsanmartino.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Gipponi
authors.affiliation: Division of Surgical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Solari
authors.affiliation: Division of Surgical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Giovinazzo
authors.affiliation: Division of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Queirolo
authors.affiliation: Division of Surgery, Breast Unit, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bertoglio
authors.affiliation: Division of Nuclear Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Villa
authors.affiliation: Division of Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Gualco
authors.affiliation: Dermatologic Unit, Giannina Gaslini Istitute, Genoa, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Bleidl
authors.affiliation: Division of Surgical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico "Azienda Ospedaliera Universitaria San Martino-IST", Genoa, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Cafiero
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D015996:Survival Rate
keywords: Melanoma; recurrence; sentinel lymph node