Prognostic false-positivity of the sentinel node in melanoma

  title={Prognostic false-positivity of the sentinel node in melanoma},
  author={J. Meirion Thomas},
  journal={Nature Clinical Practice Oncology},
  • J. Thomas
  • Published 2008
  • Medicine
  • Nature Clinical Practice Oncology
It is a basic tenet of the sentinel lymph-node biopsy procedure that all positive sentinel lymph nodes will inevitably progress to palpable nodal recurrence if not removed. Comparison of survival is, therefore, considered permissible among patients with positive sentinel lymph nodes who undergo early lymphadenectomy with that among patients who have delayed lymphadenectomy for palpable regional node metastasis, providing that survival is calculated from the date of wide local excision of the… 

False‐positivity in the sentinel lymph nodes in melanoma and breast cancer

In a recent issue of Cancer, Pasquali et al presented a personal series and literature meta-analysis that concluded that, in melanoma, early lymphadenectomy for sentinel lymph node (SLN)-positive

Reply to False‐positivity in the sentinel lymph nodes in melanoma and breast cancer

In a recent issue of Cancer, Pasquali et al presented a personal series and literature meta-analysis that concluded that, in melanoma, early lymphadenectomy for sentinel lymph node (SLN)-positive

New developments in sentinel node staging in melanoma: controversies and alternatives

Sentinel node tumor burden is an extra dimension to predict prognosis, although the correct group to undergo a completion lymph node dissection is not yet identified, although it might not become viable disease.

Why perform sentinel-lymph-node biopsy in patients with melanoma?

Although SLNB does provide prognostic information, patients should be clearly informed that SLNB, possibly followed by lymph-node dissection, is an expensive procedure with associated morbidity that confers no survival benefit.

Completion lymph node dissection after a positive sentinel node: no longer a must?

This review analyzed the necessity of CLND in sentinel node positive patients and found patients with less than 0.1 mm metastases seem to have similar prognosis as sentinel nodes negative patients, especially when located in the subcapsular area.

Sentinel lymph node biopsy for melanoma: an important risk‐stratification tool

The rationale for sentinel lymph node biopsy is put into context in light of both advances in the management of patients with advanced melanoma and the recent publication of the final report of the Multicenter Selective Lymphadenectomy Trial (MSLT-I).

Radioguided Sentinel Lymph Node Mapping and Biopsy in Cutaneous Melanoma

The Multicenter Selective Lymphadenectomy Trial I has shown that the procedure leads to improved survival when combined with completion lymph node dissection in lymph node-positive patients with an intermediate Breslow thickness melanoma.

Sentinel lymph node biopsy and melanoma: 2010 update Part I.

Impact of Sentinel Node Biopsy on Outcome in Melanoma

This book chapter examines the impact of sentinel node biopsy on outcome in melanoma, and critically assess other emerging strategies in the management of melanoma including frozen section analysis of the sentinel nodes, imprint cytology of theSendinel node, targeted assessment of the regional lymph node basin, the use of risk stratification algorithms of histological factors of the primary tumour and microRNAs.

Importance of tumor load in the sentinel node in melanoma: clinical dilemmas

Ultrasound-guided fine-needle aspiration cytology is emerging as a staging tool for high-risk patients, but more research is necessary before this can change clinical practice.



Should Tumor Mitotic Rate and Patient Age, As Well As Tumor Thickness, be Used to Select Melanoma Patients for Sentinel Node Biopsy?

Prognosis and sentinel node status are closely associated, so it came as no surprise that Sondak et al.,5 in an article published in this issue of the Annals of Surgical Oncology, found that both TMR and tumor thickness were predictors of sentinel nodes positivity.


The value of the SNB technique, not only as a less invasive and less morbid alternative to CLND, but also as a valuable staging procedure and thus a guide to management, was quickly appreciated and it soon became a routine procedure in most large melanoma treatment centres worldwide.

Prognostic importance of lymph node tumor burden in melanoma patients staged by sentinel node biopsy

Microstaging of melanoma sentinel lymph node/CLND specimens by using the diameter of the largest tumor deposit is a highly significant predictor of early relapse and survival.

Sentinel-node biopsy or nodal observation in melanoma.

The staging of intermediate-thickness primary melanomas according to the results of sentinel-node biopsy provides important prognostic information and identifies patients with nodal metastases whose survival can be prolonged by immediate lymphadenectomy.

Multi-institutional melanoma lymphatic mapping experience: the prognostic value of sentinel lymph node status in 612 stage I or II melanoma patients.

Lymphatic mapping and SLN biopsy is highly accurate in staging nodal basins at risk for regional metastases in primary melanoma patients and identifies those who may benefit from earlier lymphadenectomy.

Clinical outcome of stage I/II melanoma patients after selective sentinel lymph node dissection: long-term follow-up results.

With a success rate of 99.5% and a false-negative rate of 9% after long-term follow-up, the triple-technique SLN procedure is a reliable and accurate method and not all SLN-positive patients have a poor prognosis.

Mitotic Rate and Younger Age Are Predictors of Sentinel Lymph Node Positivity: Lessons Learned From the Generation of a Probabilistic Model

This model may identify patients with thin melanoma at sufficient risk for metastases to justify SLN biopsy and suggest that younger patients with tumors <1 mm may still have a substantial risk for a positive SLN, especially if the mitotic rate is high.

Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative?

The data suggest that patients with sub-micrometastases in the SN may be judged as SN negative, as non-stage III, and are highly unlikely to benefit from CLND, which is no longer recommend.

Characterization of Micrometastatic Disease in Melanoma Sentinel Lymph Nodes by Enhanced Pathology: Recommendations for Standardizing Pathologic Analysis

Assessment of the yield of metastatic melanoma detected in SLNs deemed negative by initial routine pathologic analysis concluded that patients with EPA-detected disease and those with negative SLNs by EPA demonstrated improved recurrence-free and disease-specific survival compared with patients with RPA-detection disease inSLNs.