Sentinel lymph node biopsy in melanoma: Our 8-year clinical experience in a single French institute (2002–2009)

Caroline Biver-Dalle,Hatem Boulahdour,Frances Sheppard,Delphine Delroeux,François Aubin,Philippe Humbert,Fabien Pelletier,Eve Puzenat,Marc Puyraveau

doi:10.1186/1471-5945-12-21

Abstract

BackgroundSince the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma.MethodsA single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma (tumour thickness > 1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head and neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and intraoperative gamma probe interrogation.ResultsThe SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was significantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5 (5–97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p = 0.002). Five-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant difference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p = 0.0006 and p = 0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients.ConclusionOur data confirm previous studies and support the clinical usefulness of SLNB as a reliable and accurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in patients with positive SLN remains to be demonstrated.

Highlights

Since the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial
Its main short term aim is the early identification of patients with occult nodal metastasis, known as micrometastasis, who might benefit from complete lymph node dissection (CLND)
We present our 8-year consecutive clinical experience of performing SLNB for CM

Summary

Introduction

Since the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma. Since its introduction in 1992 [1], the role of sentinel lymph node biopsy (SLNB) in melanoma care remains controversial and is not included in most guidelines for the management of melanoma in Europe [2]. The long term aim is to provide a more accurate basis for formulating a prognosis than do standard retrospective studies have shown similar results and the influence of SLNB and CLND on long term patient survival as well as its therapeutic role are still debated [5]. We evaluated the outcome of patients in terms of disease progression and mortality based on the SLNB result

Methods

Results

Discussion

Conclusion