Prospective evaluation of selective lymph node biopsy for cutaneous malignant melanoma

Brian W. Loggie, Art A. Hosseinian, Nat E. Watson

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Some patients presenting with cutaneous malignant melanoma without palpable adenopathy have regional metastatic disease. We have applied the technique of gamma probe-directed selective lymph node biopsy and used the results to direct further therapy. The results of a prospective nonrandomized clinical study are presented. Between November 1993 and December 1996, 63 patients with a diagnosis of primary cutaneous malignant melanoma underwent lymphoscintigraphy with technetium sulfur colloid followed by gamma probe- guided lymph node biopsy. There were 32 (51%) women and 31 (49%) men with a mean age of 51.1 years (median, 50; range, 13-87). Mean Breslow thickness was 2.13 mm (range, 0.5-15.0 mm; median, 1.56 mm). Primary locations were head and neck in 8 (13%), trunk in 24 (38%), upper extremity in 13 (21%), and lower extremity in 18 (29%). Selective lymph node biopsy was done on an outpatient basis with local anesthesia in 49 cases (78%) and in the operating room with general anesthetic in 14 patients (22%). One lymph node site was biopsied in 46 patients (73%), two sites in 16 (25%), and three in 1 (2%), for a total of 81 selective lymph node biopsy sites, mean 1.29 per patient. The mean number of labeled lymph nodes removed per site per patient was 1.64 (range, 1-5). Seroma or infection occurred in 6 patients (10%). Micrometastatic disease was identified in nine selective lymph node biopsy sites in eight patients. Of eight patients undergoing lymph node dissection, 5 (63%) had no additional pathological lymph node involvement. With a mean follow-up of 579 days from selective lymph node biopsy (median, 594; range, 36-1157), 59 (94%) have no evidence of disease. Three patients have died, 2 with systemic disease (475 and 1149 days) and 1 from a myocardial infarction (380 days). No patient has failed with regional-only recurrence. Gamma probe- directed selective lymph node biopsy is a straightforward procedure that can be done in the outpatient setting and facilitates management of patients with cutaneous malignant melanoma.

Original languageEnglish
Pages (from-to)1051-1058
Number of pages8
JournalAmerican Surgeon
Volume63
Issue number12
StatePublished - 1997
Externally publishedYes

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Lymph Nodes
Biopsy
Cutaneous Malignant Melanoma
Outpatients
Technetium Tc 99m Sulfur Colloid
Lymphoscintigraphy
Seroma
General Anesthetics
Local Anesthesia
Operating Rooms
Lymph Node Excision
Upper Extremity
Lower Extremity
Neck
Myocardial Infarction
Head
Recurrence
Infection

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Prospective evaluation of selective lymph node biopsy for cutaneous malignant melanoma. / Loggie, Brian W.; Hosseinian, Art A.; Watson, Nat E.

In: American Surgeon, Vol. 63, No. 12, 1997, p. 1051-1058.

Research output: Contribution to journalArticle

Loggie, Brian W. ; Hosseinian, Art A. ; Watson, Nat E. / Prospective evaluation of selective lymph node biopsy for cutaneous malignant melanoma. In: American Surgeon. 1997 ; Vol. 63, No. 12. pp. 1051-1058.
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abstract = "Some patients presenting with cutaneous malignant melanoma without palpable adenopathy have regional metastatic disease. We have applied the technique of gamma probe-directed selective lymph node biopsy and used the results to direct further therapy. The results of a prospective nonrandomized clinical study are presented. Between November 1993 and December 1996, 63 patients with a diagnosis of primary cutaneous malignant melanoma underwent lymphoscintigraphy with technetium sulfur colloid followed by gamma probe- guided lymph node biopsy. There were 32 (51{\%}) women and 31 (49{\%}) men with a mean age of 51.1 years (median, 50; range, 13-87). Mean Breslow thickness was 2.13 mm (range, 0.5-15.0 mm; median, 1.56 mm). Primary locations were head and neck in 8 (13{\%}), trunk in 24 (38{\%}), upper extremity in 13 (21{\%}), and lower extremity in 18 (29{\%}). Selective lymph node biopsy was done on an outpatient basis with local anesthesia in 49 cases (78{\%}) and in the operating room with general anesthetic in 14 patients (22{\%}). One lymph node site was biopsied in 46 patients (73{\%}), two sites in 16 (25{\%}), and three in 1 (2{\%}), for a total of 81 selective lymph node biopsy sites, mean 1.29 per patient. The mean number of labeled lymph nodes removed per site per patient was 1.64 (range, 1-5). Seroma or infection occurred in 6 patients (10{\%}). Micrometastatic disease was identified in nine selective lymph node biopsy sites in eight patients. Of eight patients undergoing lymph node dissection, 5 (63{\%}) had no additional pathological lymph node involvement. With a mean follow-up of 579 days from selective lymph node biopsy (median, 594; range, 36-1157), 59 (94{\%}) have no evidence of disease. Three patients have died, 2 with systemic disease (475 and 1149 days) and 1 from a myocardial infarction (380 days). No patient has failed with regional-only recurrence. Gamma probe- directed selective lymph node biopsy is a straightforward procedure that can be done in the outpatient setting and facilitates management of patients with cutaneous malignant melanoma.",
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