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A Sentinel Node Biopsy Does Not Increase the Incidence of In-Transit Metastasis in Patients With Primary Cutaneous Melanoma

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Abstract

Background

It has been suggested that performing a sentinel node biopsy (SNB) in patients with cutaneous melanoma increases the incidence of in-transit metastasis (ITM).

Methods

ITM rates for 2018 patients with primary melanomas ≥1.0 mm thick treated at a single institution between 1991 and 2000 according to 3 protocols were compared: wide local excision (WLE) only (n = 1035), WLE plus SNB (n = 754), and WLE plus elective lymph node dissection (n = 229).

Results

The incidence of ITM for the three protocols was 4.9%, 3.6%, and 5.7%, respectively (not significant), and as a first site of recurrent disease the incidence was 2.5%, 2.4%, and 4.4%, respectively (not significant). The subset of patients who were node positive after SNB and after elective lymph node dissection also had similar ITM rates (10.8% and 7.1%, respectively; P = .11). On multivariate analysis, primary tumor thickness and patient age predicted ITM as a first recurrence, but type of treatment did not. Patients who underwent WLE only and who had a subsequent therapeutic lymph node dissection (n = 149) had an ITM rate of 24.2%, compared with 10.8% in patients with a tumor-positive sentinel node treated with immediate dissection (n = 102; P = .03).

Conclusions

Performing an SNB in patients with melanoma treated by WLE does not increase the incidence of ITM.

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Acknowledgments

Supported by the Melanoma Foundation of the University of Sydney. D.v.P. was a Sydney Melanoma Unit research student supported by the Dutch Cancer Foundation (Koningin Wilhelmina Fonds), the Dutch Skin Foundation (Stichting Nederlands Huidfonds), and the Dutch Society for Physics and Medical Science (Nederlands Genootschap voor Natuur-, Genees- en Heelkunde). J.G.M. was a Sydney Melanoma Unit research fellow supported by the Walter C. MacKenzie-Scotiabank Fellowship.

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Authors and Affiliations

  1. Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia

    Daan van Poll MD, John F. Thompson MD, Marjorie H. Colman BSc, J. Gregory McKinnon MD, Robyn P. M. Saw MB, MS, Jonathan R. Stretch MB, BS, DPhil, Richard A. Scolyer MB, BS & Roger F. Uren MD

  2. Discipline of Surgery, The University of Sydney, Sydney, New South Wales 2006, , Australia

    John F. Thompson MD, Robyn P. M. Saw MB, MS & Jonathan R. Stretch MB, BS, DPhil

  3. Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050, Australia

    Richard A. Scolyer MB, BS

  4. Discipline of Medicine, The University of Sydney, Sydney, New South Wales, 2006, Australia

    Roger F. Uren MD

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  1. Daan van Poll MD
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Correspondence to John F. Thompson MD.

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Published by Springer Science+Business Media, Inc. © 2005 The Society of Surgical Oncology, Inc.

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van Poll, D., Thompson, J.F., Colman, M.H. et al. A Sentinel Node Biopsy Does Not Increase the Incidence of In-Transit Metastasis in Patients With Primary Cutaneous Melanoma. Ann Surg Oncol 12, 597–608 (2005). https://doi.org/10.1245/ASO.2005.08.012

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