Don’t perform lymphoscintigraphy and radioguided biopsy of the sentinel node in patients affected by cutaneous melanoma thinner than 0.75 mm, with no ulceration and mitotic rate <1/mm2

Don’t perform lymphoscintigraphy and radioguided biopsy of the sentinel node in patients affected by cutaneous melanoma thinner than 0.75 mm, with no ulceration and mitotic rate <1/mm2

Type of practice

Imaging

Age

Adult, Geriatric

Topic Area

Nuclear Medicine

The treatment of choice for these patients is adequate surgical removal alone of the primitive tumour. Given the optimal prognosis (97% survival at 10 years), radioguided biopsy of the sentinel node would imply useless exposure to ionizing radiations, as well as surgical “overtreatment” of selective removal of the sentinel node. The NCCN guidelines (version 4.2014) indicate that the search for the sentinel node, at any anatomical site, can be considered on an individual basis in patients with melanomas of thickness between 0.75 and <1 mm with at least 1 mitosis/mm2 or with ulceration, and for all melanomas of thickness between 1 and 4 mm. Biopsy of the sentinel node can be recommended for staging and to facilitate loco-regional control of the disease in patients with T4 melanoma or > 4 mm of Breslow thickness. It is important that the search for the sentinel node is discussed case by case in a multidisciplinary context, taking into account other prognostic variables including age, sex and site of the lesion, which can guide the decision-making process.

Sources

1. J.G. McKinnon, X. Qin Yu, W.H. McCarthy, J.F. Thompson Prognosis for Patients with Thin Cutaneous Melanoma Long-Term Survival Data from the New South Wales Central Cancer Registry and the Sydney Melanoma Unit. Cancer 2003; 98: 1223–31.
2. S.L. Wong, M.S. Brady, K.J. Busam, D.G. Coit. Results of Sentinel Lymph Node Biopsy in Patients With Thin Melanoma. Annals of Surgical Oncology, 13(3): 302-309, 2006.
3. M.F. Kalady, R.R. White, J. L. Johnson, D. S. Tyler, H.F. Seigler. Thin Melanomas Predictive Lethal Characteristics From a 30-Year Clinical Experience. Annals of Surgery 2003;238: 528–537.
4. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, Buzaid AC, Cochran AJ, Coit DG, Ding S, Eggermont AM, Flaherty KT, Gimotty PA, Kirkwood JM, McMasters KM, Mihm MC Jr, Morton DL, Ross MI, Sober AJ, Sondak VK. Final Version of 2009 AJCC Melanoma Staging and Classification J Clin Oncol 2009, (27): 6199-6206).

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.