Melanoma: Study Examines Metastases in Nonhottest Sentinel Nodes

MedicalResearch.com Interview with:
Lyn McDivitt Duncan, MD
Professor of Pathology, Harvard Medical School
Chief, Dermatopathology Unit and
Su Luo, MD Dermatology Resident
Massachusetts General Hospital
Boston, MA 02114

Medical Research: What is the background for this study? What are the main findings?

Response: We studied 475 patients with cutaneous melanoma diagnosed at the Massachusetts General Hospital (MGH) who also had a sentinel lymph node biopsy procedure performed.  There is a practice gap in the sentinel lymph node biopsy procedure ranging from removal of one “sentinel” lymph node to removing the hottest lymph node and any lymph nodes with radioactive tracer of 10% or more of the hottest lymph node’s counts (with an average of three lymph nodes removed).  At the MGH we use this latter method.  We examined the sentinel lymph nodes in each case to determine whether the positive cases with microscopic melanoma metastases had metastases only in the most radioactive, or “hottest”, node or whether tumor was also present in the less hot nodes. We found that in 19% of positive cases there were metastases present only in the less hot nodes. We also performed survival analysis and showed that the less hot nodal positive cases are of equivalent prognostic significance.  We found that removal of only the hottest lymph node would have led to under-staging of 19% of patients with melanoma.

Medical Research: What should clinicians and patients take away from your report?

Response: Clinically significant metastases may occur in lymph nodes other than the primary draining or “hottest” lymph node.  Our study reinforces the practice of removing all the sentinel nodes down to 10% of the most radioactive, thus capturing these less hot nodes.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: We hope that our study can drive further research into developing practice standards for sentinel lymph node biopsy and also provide the basis for additional studies that investigate sentinel lymph node metastases and prognosis in patients with primary cutaneous melanoma.

Citation:

 

 

MedicalResearch.com Interview with: Lyn McDivitt Duncan, MD, Professor of Pathology, Harvard Medical School; Chief, Dermatopathology Unit and Su Luo, MD Dermatology Resident (2015). Melanoma: Study Examines Metastases in Nonhottest Sentinel Nodes