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Hur, Kim, Lee, Kim, Choi, Kim, Lim, Pyon, Mun, Choe, Lee, Kim, Nam, Yang, and Kim: Clinical Usefulness of Sentinel Lymph Node Biopsy in the Surgical Treatment of Malignant Melanoma
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(3): 163-172.

Published online: 3 September 2010

DOI: https://doi.org/10.4174/jkss.2010.79.3.163

Clinical Usefulness of Sentinel Lymph Node Biopsy in the Surgical Treatment of Malignant Melanoma

Sung Mo Hur, M.D., Sung Hoon Kim, M.D., Se Kyung Lee, M.D., Wan Wook Kim, M.D., Jae Hyuck Choi, M.D., Sangmin Kim, Ph.D., So Young Lim, Ph.D.1, Jai Kyung Pyon, Ph.D.1, Goo Hyun Mun, M.D.1, Jun-Ho Choe, M.D., Jeong Eon Lee, Ph.D., Jee Soo Kim, Ph.D., Seok-Jin Nam, Ph.D., Jung-Hyun Yang, Ph.D., Jung-Han Kim, Ph.D.

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

1Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Corresponding author (jinnee.kim@samsung.com)

Received 18 March 2010       Accepted 24 May 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

The aim of this study was to evaluate the usefulness of sentinel lymph node (SLN) biopsy in the treatment of primary melanoma.

Methods

Fifty-one cases that were diagnosed as malignant melanoma of the skin without clinical evidence of regional lymph node metastasis and underwent SLN biopsy at Samsung Medical Center were analyzed retrospectively. A lymphoscintigraphy with peritumoral injection of radionuclide was performed preoperatively. SLNs were identified using a hand-held gamma probe and by methylene blue dye injection intraoperatively.

Results

Twenty patients (39%) had metastasis in the SLN and they underwent immediate complete radical dissection of the nodal basin. Among the 20 patients who had SLN metastasis, additional metastatic lymph nodes were detected in 5 patients after the complete lymph node dissection. When several clinico-pathologic parameters such as gender, age, primary tumor location, draining nodal basin, tumor depth and size of tumor were compared between SLN positive group and negative group, there was a significant difference in the mean thickness of melanoma between SLN (+) group (5±2.9 mm) and SLN (-) group (4.5±5.0 mm) (P<0.05). In the same way, as the thickness of melanoma increased, positive SLN were detected more frequently (P<0.05). Recurrences occurred in 18 patients (35.3%) during the follow-up period, but only one case in 31 patients with negative SLN recurred at the SLN basin without evidence of distant or loco-regional recurrence (false negative rate 4.8%). Lymphedema of extremity developed in 9 patients who underwent complete radical lymph node dissection and 2 patients who underwent only SLN biopsy had a very mild-form lymphedema.

Conclusion

SLN biopsy in the treatment of cutaneous melanoma is a safe, useful and feasible method to identify status of regional lymph node with low false negative rates and low complications.

Keywords: Malignant melanoma, Sentinel lymph node, Lymphoscintigraphy, Gamma probe

Figures and Tables

Fig. 1
F-18 fluorodeoxyglucose (FDG) positron emission tomography. It shows a malignant lesion on right finger tip (arrow).
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Fig. 2
Tc-99m labeled lymphoscintigraphy. Sentinel lymph node is identified as a hot uptake in right axillary area.
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Fig. 3
Recurrence free survival between sentinel lymph node (SLN) positive group and SLN negative group.
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Table 1
Clinicopathologic characteristics of the patients
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*Mean±SD (range); †SLN = sentinel lymph node.

Table 2
Comparison of characteristics between SLN positive and SLN negative group
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*SLN = sentinel lymph node; †SD = standard deviation; ‡NS = not significant; §Exclude 3 unknown cases; ∥Exclude 10 unknown cases.

Table 3
Number of cases according to depth and metastatic sentinel lymph node
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*Exclude 3 unknown cases.

Table 4
Recurrence by histologic status of sentinel lymph node
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*SLN = sentinel lymph node; †LN = lymph node; ‡Previous unmapped basin; §CLN = complete lymph node.

Table 5
Cases of recurrence on SLN* basin in SLN negative patient
jkss-79-163-i005

*SLN = sentinel lymph node; †SLNB = sentinel lymph node biopsy; ‡Lt = left; §LN= lymph node; ∥Rt = right.

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