Abstract
BackgroundCompletion lymph node dissection (CLND) is the gold standard treatment for patients with a positive sentinel lymph node (SLN) biopsy. Considering the morbidity associated with CLND it is important to identify histological features of the primary tumor and/or of SLN metastasis that could help to spare from CLND a subset of patients who have a very low risk of non-SLN metastasis. The objective of this study is to identify patients with a very low risk to develop non-SLNs recurrences and to limit unnecessary CLND.MethodsA retrospective long-term study of 80 melanoma patients with positive SLN, undergone CLND, was assessed to define the risk of additional metastasis in the regional nodal basin, on the basis of intranodal distribution of metastatic cells, using the micro-morphometric analysis (Starz classification).ResultsThis study demonstrates that among the demographic and pathologic features of primary melanoma and of SLN only the Starz classification shows prognostic significance for non-SLN status (p<0.0001). This parameter was also significantly associated with disease-free survival rate (p<0.0013).ConclusionThe Starz classification can help to identify, among SLN positive patients, those who can have a real benefit from CLND. From the clinical point of view this easy and reliable method could lead to a significant reduction of unnecessary CLND in association with a substantial decrease in morbidity. The study results indicate that most of S1 subgroup patients might be safely spared from completion lymphatic node dissection. Furthermore, our experience demonstrated that Starz classification of SLN is a safe predictive index for patient stratification and treatment planning.
Highlights
The sentinel lymph node (SLN) is the first lymph node reached by metastasizing cancer cells from a primary tumor
Considering the morbidity associated with Completion lymph node dissection (CLND) it will be important to identify histological features of the primary tumour and/or of SLN metastases that could help to spare from CLND a subset of patients who are unlike to have metastatic non-SLNs and will not take any benefit from further nodal dissection
We retrospectively evaluated the disease-free survival (DFS) rate and the overall survival (OS) rate of patients, considering several clinical and pathological aspects of primary melanoma compared with the findings of micromorphometric analysis performed on the excised lymphatic nodes
Summary
The sentinel lymph node (SLN) is the first lymph node reached by metastasizing cancer cells from a primary tumor. In 1992 Morton et al have demonstrated that it is rare that melanoma cells skip the sentinel lymph node and metastasize in other nodes [1]. Considering the morbidity associated with CLND (paresthesias, wound infection, seroma and lymphoedema) it will be important to identify histological features of the primary tumour and/or of SLN metastases that could help to spare from CLND a subset of patients who are unlike to have metastatic non-SLNs and will not take any benefit from further nodal dissection. Considering the morbidity associated with CLND it is important to identify histological features of the primary tumor and/or of SLN metastasis that could help to spare from CLND a subset of patients who have a very low risk of non-SLN metastasis.
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