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Micrometastasis to In-Transit Lymph Nodes From Extremity and Truncal Malignant Melanoma

From the Departments of Surgery (MCT, LHN, REA, SPLL), Nuclear Medicine (ETM), and Pathology (PAT), and Melanoma Center (RWS, MK-S), University of California at San Francisco Medical Center at Mount Zion and UCSF Comprehensive Cancer Center, San Francisco, California.

Correspondence: Address correspondence and reprint requests to: Stanley P.L. Leong, MD, Director of Sentinel Lymph Node Program, Department of Surgery, Member, UCSF Comprehensive Cancer Center, 1600 Divisadero Street, Suite C333, San Francisco, CA 94115; Fax: 415-353-7721; E-mail: leongs{at}surgery.ucsf.edu

Background: The sentinel lymph node (SLN) is the first lymph node in the regional nodal basin to receive metastatic cells. In-transit nodes are found between the primary melanoma site and regional nodal basins. To date, this is one of the first reports on micrometastasis to in-transit nodes.

Methods: Retrospective database and medical records were reviewed from October 21, 1993, to November 19, 1999. At the UCSF Melanoma Center, patients with tumor thickness >1 mm or <1 mm with high-risk features are managed with preoperative lymphoscintigraphy, selective SLN dissection, and wide local excision.

Results: Thirty (5%) out of 557 extremity and truncal melanoma patients had in-transit SLNs. Three patients had positive in-transit SLNs and negative SLNs in the regional nodal basin. Two patients had positive in-transit and regional SLNs. Three patients had negative in-transit SLNs but positive regional SLNs. The remaining 22 patients were negative for in-transit and regional SLNs.

Conclusions: In-transit SLNs may harbor micrometastasis. About 10% of the time, micrometastasis may involve the in-transit and not the regional SLN. Therefore, both in-transit and regional SLNs should be harvested.

Key Words: Melanoma • Micrometastasis • In-transit sentinel lymph node

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