Skip to main content

Advertisement

Log in

Sentinel Node Dissection Delays Recurrence and Prolongs Melanoma-Related Survival: An Analysis of 673 Patients from a Single Center with Long-Term Follow-Up

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The status of the sentinel lymph node is an important predictor for survival in melanoma patients, but it is still unclear if early removal of micrometastases by sentinel lymph node dissection (SLND) alters survival. A large series of melanoma patients from a single center with long-term follow-up was analyzed with regard to a possible effect of SLND on the prognosis.

Materials and Methods

A total of 673 consecutive melanoma patients were assessed treated in our center either without SLND (377 patients, pre-SLN group, between January 1995 and March 2000) or with SLND (296 patients, SLN group, between April 2000 and March 2003). The median follow-up was 64.0 months in the pre-SLN and 72.5 months in the SLN group.

Results

The pre-SLN group and SLN group did not differ significantly with regard to characteristics of the primary melanoma thickness and ulceration, sex, and age. Kaplan–Meier analyses showed a significantly better recurrence-free survival (P < .001), distant metastases free survival (P = .006), and overall survival (P = .049) for patients of the SLN group; the 5-year melanoma-specific survival rates were 80.3% in pre-SLN patients and 84.8% in SLN patients. Initial metastases in the in-transit region and distant locations were of similar frequency in the pre-SLN and SLN groups (P = .191 and P = .959, respectively), but initial regional lymph node metastases were significantly more frequent in the pre-SLN group (P < .001).

Conclusions

Our data point toward a subgroup of melanoma patients who might have a prognostic benefit from SLN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.

    Article  PubMed  Google Scholar 

  2. Gershenwald JE, Thompson W, Mansfield PF, Lee JE, Colome MI, Tseng CH, et al. Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients. J Clin Oncol. 1999;17:976–83.

    CAS  PubMed  Google Scholar 

  3. Gutzmer R, Al Ghazal M, Geerlings H, Kapp A. Sentinel node biopsy in melanoma delays recurrence but does not change melanoma-related survival: a retrospective analysis of 673 patients. Br J Dermatol. 2005;153:1137–41.

    Article  CAS  PubMed  Google Scholar 

  4. McMasters KM. What good is sentinel lymph node biopsy for melanoma if it does not improve survival? Ann Surg Oncol. 2004;11:810–2.

    Article  PubMed  Google Scholar 

  5. Medalie N, Ackerman AB. Sentinel node biopsy has no benefit for patients whose primary cutaneous melanoma has metastasized to a lymph node and therefore should be abandoned now. Br J Dermatol. 2004;151:298–307.

    Article  CAS  PubMed  Google Scholar 

  6. Morton DL, Cochran AJ. The case for lymphatic mapping and sentinel lymphadenectomy in the management of primary melanoma. Br J Dermatol. 2004;151:308–19.

    Article  CAS  PubMed  Google Scholar 

  7. Kretschmer L, Hilgers R, Mohrle M, Balda BR, Breuninger H, Konz B, et al. Patients with lymphatic metastasis of cutaneous malignant melanoma benefit from sentinel lymphadenectomy and early excision of their nodal disease. Eur J Cancer. 2004;40:212–8.

    Article  CAS  PubMed  Google Scholar 

  8. Morton DL, Hoon DS, Cochran AJ, Turner RR, Essner R, Takeuchi H, et al. Lymphatic mapping and sentinel lymphadenectomy for early-stage melanoma: therapeutic utility and implications of nodal microanatomy and molecular staging for improving the accuracy of detection of nodal micrometastases. Ann Surg. 2003;238:538–49.

    PubMed  Google Scholar 

  9. Starz H, De Donno A, Balda BR. The Augsburg experience: histological aspects and patient outcomes. Ann Surg Oncol. 2001;8:48S–51S.

    CAS  PubMed  Google Scholar 

  10. Thomas JM. Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol. 2008;5:18–23.

    Article  PubMed  Google Scholar 

  11. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006;355:1307–17.

    Article  CAS  PubMed  Google Scholar 

  12. Gimotty PA, Yoon F, Hammond R, Rosenbaum P, Guerry D. Therapeutic effect of sentinel lymph node biopsy in melanoma remains an open question. J Clin Oncol. 2009;27:4236–8.

    Article  PubMed  Google Scholar 

  13. Thomas JM. Sentinel-node biopsy in melanoma. N Engl J Med. 2007;356:418–21.

    Article  CAS  PubMed  Google Scholar 

  14. Amersi F, Morton DL. The role of sentinel lymph node biopsy in the management of melanoma. Adv Surg. 2007;41:241–56.

    Article  PubMed  Google Scholar 

  15. Gutzmer R, Kaspari M, Brodersen JP, Mommert S, Voelker B, Kapp A, et al. Specificity of tyrosinase and HMB45 PCR in the detection of melanoma metastases in sentinel lymph node biopsies. Histopathology. 2002;41:510–8.

    Article  CAS  PubMed  Google Scholar 

  16. van Akkooi AC, Voit CA, Verhoef C, Eggermont AM. New developments in sentinel node staging in melanoma: controversies and alternatives. Curr Opin Oncol. 2010;22:169–77.

    Article  PubMed  Google Scholar 

  17. van Akkooi AC, Nowecki ZI, Voit C, Schafer-Hesterberg G, Michej W, de Wilt JH, et al. Sentinel node tumor burden according to the Rotterdam criteria is the most important prognostic factor for survival in melanoma patients: a multicenter study in 388 patients with positive sentinel nodes. Ann Surg. 2008;248:949–55.

    Article  PubMed  Google Scholar 

  18. Satzger I, Volker B, Al Ghazal M, Meier A, Kapp A, Gutzmer R. Prognostic significance of histopathological parameters in sentinel nodes of melanoma patients. Histopathology. 2007;50:764–72.

    Article  CAS  PubMed  Google Scholar 

  19. van Akkooi A, de Wilt J, Verhoef C, Schmitz P, van Geel A, Eggermont A, et al. Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol. 2006;17:1578–85.

    Article  PubMed  Google Scholar 

  20. Meier A, Satzger I, Voelker B, Kapp A, Gutzmer R. Comparison of classification systems in melanoma sentinel nodes—An analysis of 697 patients from a single center. Cancer. 2010;116:3178–88.

    Article  PubMed  Google Scholar 

  21. Murugkar P, Azawi K, Humzah D. The sleeper cells: delayed sentinel lymph node biopsy. J Plast Reconstr Aesthet Surg. 2007;60:1357–60.

    Article  CAS  PubMed  Google Scholar 

  22. Starz H, Siedlecki K, Balda BR. Sentinel lymphadenectomy and s-classification: a successful strategy for better prediction and improvement of outcome of melanoma. Ann Surg Oncol. 2004;11:162S–8S.

    PubMed  Google Scholar 

  23. Satzger I, Völker B, Meier A, Schenck F, Kapp A. Gutzmer R. Prognostic significance of isolated HMB45 or Melan A positive cells in Melanoma sentinel lymph nodes. Am J Surg Pathol. 2007;31:1175–80.

    Article  PubMed  Google Scholar 

  24. Kretschmer L, Beckmann I, Thoms KM, Haenssle H, Bertsch HP, Neumann C. Sentinel lymphadenectomy does not increase the risk of loco-regional cutaneous metastases of malignant melanomas. Eur J Cancer. 2005;41:531–8.

    Article  CAS  PubMed  Google Scholar 

  25. Thomas JM, Patocskai EJ. The argument against sentinel node biopsy for malignant melanoma. BMJ. 2000;321:3–4.

    Article  CAS  PubMed  Google Scholar 

  26. Thomas JM, Clark MA. Selective lymphadenectomy in sentinel node-positive patients may increase the risk of local/in-transit recurrence in malignant melanoma. Eur J Surg Oncol. 2004;30:686–91.

    Article  CAS  PubMed  Google Scholar 

  27. Kretschmer L, Beckmann I, Thoms KM, Mitteldorf C, Bertsch HP, Neumann C. Factors predicting the risk of in-transit recurrence after sentinel lymphadenectomy in patients with cutaneous malignant melanoma. Ann Surg Oncol. 2006;13:1105–12.

    Article  PubMed  Google Scholar 

  28. Francken AB, Accortt NA, Shaw HM, Wiener M, Soong SJ, Hoekstra HJ, et al. Prognosis and determinants of outcome following locoregional or distant recurrence in patients with cutaneous melanoma. Ann Surg Oncol. 2008;15:1476–84.

    Article  PubMed  Google Scholar 

  29. Masback A, Olsson H, Westerdahl J, Ingvar C, Jonsson N. Prognostic factors in invasive cutaneous malignant melanoma: a population-based study and review. Melanoma Res. 2001;11:435–45.

    Article  CAS  PubMed  Google Scholar 

  30. Janku F, Kurzrock R. Adjuvant interferon in high-risk melanoma: end of the era? J Clin Oncol. 2010;28:e15–6.

    Article  CAS  PubMed  Google Scholar 

  31. Garbe C, Eigentler T. Diagnosis and treatment of cutaneous melanoma: state of the art 2006. Melanoma Res. 2007;17:117–27.

    Article  PubMed  Google Scholar 

  32. Eggermont AM, Suciu S, MacKie R, Ruka W, Testori A, Kruit W, et al. Post-surgery adjuvant therapy with intermediate doses of interferon alfa 2b versus observation in patients with stage IIb/III melanoma (EORTC 18952): randomised controlled trial. Lancet. 2005;366:1189–96.

    Article  CAS  PubMed  Google Scholar 

  33. Eggermont AM, Suciu S, Santinami M, Testori A, Kruit WH, Marsden J, et al. Adjuvant therapy with pegylated interferon alfa-2b versus observation alone in resected stage III melanoma: final results of EORTC 18991, a randomised phase III trial. Lancet. 2008;372:117–26.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to I. Satzger MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Satzger, I., Meier, A., Hoy, L. et al. Sentinel Node Dissection Delays Recurrence and Prolongs Melanoma-Related Survival: An Analysis of 673 Patients from a Single Center with Long-Term Follow-Up. Ann Surg Oncol 18, 514–520 (2011). https://doi.org/10.1245/s10434-010-1318-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-1318-3

Keywords

Navigation