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Lymphoscintigraphy and Sentinel Node Biopsy Accurately Stage Melanoma in Patients Presenting After Wide Local Excision

From the Departments of Surgery (HLE, CLS), Radiology (CDT), and Pathology (JWP), University of Virginia Health System, Charlottesville, Virginia; Vermont Cancer Center (DNK, SPH), University of Vermont, Burlington, Vermont; Department of Surgical Oncology (SM), Academisch Ziekenhuis van de Vrije Universiteit, Amsterdam, The Netherlands; Massachusetts General Hospital Cancer Center (KKT, MAG), Harvard Medical School, Boston, Massachusetts; Creighton Cancer Center (BWL), Creighton University Medical Center, Omaha, Nebraska; Baptist Hospital (PWW), Nashville, Tennessee; Charleston Area Medical Center (REK), Charleston, West Virginia; and Lankenau Hospital Cancer Center (NZC), Wynnewood, Pennsylvania.

Correspondence: Address correspondence and reprint requests to: Heather L. Evans, MD, Surgical Infectious Disease Research Laboratory, Building MR-4, Room 3156, Lane Road, Charlottesville, VA 22908; Fax: 434-243-6360; E-mail: hle2r{at}virginia.edu

Background: Patients have traditionally been considered candidates for sentinel node biopsy (SNBx) only at the time of wide local excision (WLE). We hypothesized that patients with prior WLE may also be staged accurately with SNBx.

Methods: Seventy-six patients, including 18 patients from the University of Virginia and 58 from a multicenter study of SNBx led by investigators at the University of Vermont, who had previous WLE for clinically localized melanoma underwent lymphoscintigraphy with SNBx. Median follow-up time was 38 months.

Results: Intraoperative identification of at least 1 sentinel node was accomplished in 75 patients (98.6%). The mean number of sentinel nodes removed per patient was 2.0. Eleven patients (15%) had positive sentinel nodes. Among the 64 patients with negative SNBx, 3 (4%) developed nodal recurrences in a sentinel node–negative basin simultaneous with systemic metastasis, and 1 (1%) developed an isolated first recurrence in a lymph node.

Conclusions: This multicenter study more than doubles the published experience with SNBx after WLE and provides much-needed outcome data on recurrence after SNBx in these patients. These outcomes compare favorably with the reported literature for patients with SNBx at the time of WLE, suggesting that accurate staging of the regional lymph node bed is possible in patients after WLE.

Key Words: Sentinel node biopsy • Lymphoscintigraphy • Wide local excision • Melanoma

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