title: Detailed pathological examination of completion node dissection specimens and outcome in melanoma patients with minimal (<0.1 mm) sentinel lymph node metastases.
abstract: BACKGROUND
  Nonsentinel lymph nodes (NSLNs) are rarely involved in patients with minimal volume melanoma metastases in sentinel lymph nodes (SLNs). Therefore, it has been suggested that completion lymph node dissection (CLND) is not required. However, the lack of routine immunohistochemical staining and multiple sectioning may have led to failure to identify additional positive nodes. The present study sought to more reliably determine the tumor status of NSLNs in patients with minimally involved SLNs and their clinical outcome.
  
  
  METHODS
  A total of 21 tumor-negative CLND specimens from 20 patients with SLN metastases of <0.1 mm in diameter treated between 1991 and 2013 were examined with a more detailed pathologic protocol (five new sections stained with/for H&E, S-100, HMB45, Melan-A, and H&E). Clinical follow-up data were also obtained.
  
  
  RESULTS
  Of the 343 examined NSLNs, 1 was found to harbor a 0.18-mm subcapsular sinus metastasis. No metastases were identified in the other NSLNs. Median follow-up was 48 months (range 17-130 months). Six patients (30 %) developed a recurrence. At the end of follow-up, 15 patients (75 %) were alive without sign of melanoma recurrence and 5 patients (25 %) had died of melanoma. Estimated 5-year melanoma-specific survival was 64 %. The patient with the additional positive NSLN remains without recurrence after 130 months follow-up.
  
  
  CONCLUSIONS
  Although the risk of additional nodal involvement is low, detailed pathologic examination may identify NSLN metastases not identified using routine protocols. Therefore, nodal clearance appears to be the safest option for these patients, pending the results of prospective trials.
authors.affiliation: Melanoma Institute Australia, Sydney, NSW, Australia.
authors.forename: Lodewijka H J
authors.initials: LH
authors.lastname: Holtkamp
authors.forename: Shu
authors.initials: S
authors.lastname: Wang
authors.forename: James S
authors.initials: JS
authors.lastname: Wilmott
authors.forename: Jason
authors.initials: J
authors.lastname: Madore
authors.forename: Ricardo
authors.initials: R
authors.lastname: Vilain
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: Richard A
authors.initials: RA
authors.lastname: Scolyer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000401:mortality*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; 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; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D015996:Survival Rate; D000096142:Cutaneous Malignant Melanoma