International multi-institutional management and outcome of melanoma patients with positive sentinel lymph nodes in more than one nodal basin Journal Article


Authors: Melstrom, L. G.; Taylor, E.; Kuk, D.; Frankel, T. L.; Panageas, K.; Haydu, L.; Sabel, M. S.; Thompson, J. F.; Ariyan, C.; Coit, D. G.; Brady, M. S.
Article Title: International multi-institutional management and outcome of melanoma patients with positive sentinel lymph nodes in more than one nodal basin
Abstract: Background: Melanoma patients with palpable nodal disease in more than one basin have a worse prognosis than those with single-basin disease. Little is known about the outcome of patients with microscopically positive nodal disease in more than one basin, or how they are currently managed at tertiary referral centers. Methods: We identified 97 patients with positive sentinel lymph nodes (SLNs) in more than one lymph node basin from 1994 to 2010 from three tertiary care centers. Clinical and pathologic outcome variables were analyzed. Results: Ninety-seven patients (72 men, 25 women) were identified with at least one positive SLN in at least two node basins. Most primary tumors were truncal (68, 70 %) followed by extremity (16, 17 %) and head/neck (13, 13 %). The median Breslow depth was 3.2 mm (range 0.8–12 mm), and 49 (51 %) were ulcerated. The most frequently involved nodal basins were the axilla (112, 57 %), neck (40, 20 %), and groin (24, 12 %). Seventy-seven percent (153 of 198) of all positive SLN basins underwent completion lymph node dissection (CLND). Most patients (54, 56 %) developed recurrent disease, with a median time to recurrence of 20 months. The majority of first recurrences were distant (42, 43 %), followed by regional nonnodal metastases (17, 18 %) and regional nodal metastases (16, 16 %). There was no significant difference in median overall survival between CLND versus no-CLND groups (45 vs. 30 months, respectively). Conclusions: Most melanoma patients with more than one SLN-positive basin are currently managed with CLND. Outcomes after CLND and no CLND are similarly poor; therefore, consideration of close nodal observation may be more appropriate.
Keywords: adult; controlled study; human tissue; treatment outcome; aged; cancer surgery; major clinical study; overall survival; cancer recurrence; lymph node dissection; sentinel lymph node biopsy; retrospective study; electronic medical record; cancer size; cutaneous melanoma; cancer prognosis; completion lymph node dissection; sentinel lymph node metastasis; human; male; female; article; tertiary care center; multiple lymphatic basin drainage
Journal Title: Annals of Surgical Oncology
Volume: 21
Issue: 13
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2014-12-01
Start Page: 4324
End Page: 4329
Language: English
DOI: 10.1245/s10434-014-3845-9
PROVIDER: scopus
PUBMED: 24962937
DOI/URL:
Notes: Export Date: 2 January 2015 -- Source: Scopus
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MSK Authors
  1. Katherine S Panageas
    327 Panageas
  2. Mary Sue Brady
    164 Brady
  3. Charlotte Eielson Ariyan
    77 Ariyan
  4. Daniel Coit
    415 Coit
  5. Deborah Kuk
    81 Kuk