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10.1245/ASO.2006.07.020
Annals of Surgical Oncology 13:1105-1112 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Factors Predicting the Risk of In-Transit Recurrence After Sentinel Lymphonodectomy in Patients With Cutaneous Malignant Melanoma

Lutz Kretschmer, MD, Iris Beckmann, MD, Kai-Martin Thoms, MD, Christina Mitteldorf, MD, Hans Peter Bertsch, MD and Christine Neumann, MD

Department of Dermatology, Georg-August-University Göttingen, v. Siebold-Str. 3, D-37075 Göttingen, Germany

Correspondence: Address correspondence and reprint requests to: Lutz Kretschmer, MD; E-mail: lkre{at}med.uni-goettingen.de.

Background: In-transit metastasis is an important morbidity factor after sentinel lymphonodectomy (SLNE). So far, factors posing an increased risk after SLNE have not been adequately analyzed.

Methods: Using Kaplan-Meier estimations and the Cox proportional hazards model, we analyzed the risk of developing in-transit metastases after SLNE for 328 consecutive patients (median tumor thickness, 2.0 mm; median follow-up period, 40 months).

Results: The 5-year probability of developing in-transit metastases as a first recurrence was 11.2%. After negative and positive SLNE, the probabilities were 6.3% and 24%, respectively. Patients in whom satellite metastases were excised concurrently with the primary tumor had a probability of recurrence with in-transit metastases of 41%. In sentinel lymph node (SLN)-negative patients with primary tumors having a thickness of more than 4 mm, the probability was 22.1%. Among the group of SLN-positive patients, significantly increased in-transit probabilities were observed in those with primary tumors that were thicker than 4 mm (41.8%), with tumors located on the distal extremities (42.1%), and with penetration of the nodal metastasis of >1 mm into the SLN (36%) and in patients with capsular breakthrough (63.3%). By using multifactorial analysis, the SLN status (P = .005), Breslow thickness (P = .0009), and extremity location of the primary melanoma (P = .005) significantly predicted the risk of in-transit recurrence. Satellite metastasis (P < .089), Clark level, and ulceration did not reach significance.

Conclusions: Subgroups of patients can be identified who seem to have an increased risk of developing in-transit metastases as a first recurrence after SLNE. Individualized therapeutic strategies should be developed for these patients.

Key Words: Cutaneous melanoma • Sentinel lymphonodectomy • In-transit metastases • Lymph node excision • Prognostic factors






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