C. K. Chang

Role of sentinel lymph node biopsy in patients with thin (<1 mm) primary melanoma.

Background: Thin melanomas have become increasingly prevalent, and lesions ≤1 mm in thickness are frequently diagnosed. They are considered highly curable when treated solely with wide local excision, with reported 5-year disease-free survivals of 95% to 98%. However, thin Clark level III and IV melanomas may have increased potentials for metastasizing and late recurrences because of dermal lymphatics located at the interface of the papillary and reticular dermis. We have addressed this controversial area by reviewing the outcomes of patients with invasive thin melanomas.Methods: We performed 266 sentinel lymph node biopsy procedures, using both radioisotope and blue dye, over a 5-year period. Sixty-five of the 266 invasive melanomas were thin and were treated by wide local excision and sentinel lymph node biopsy.Results: Two (3%) of the 65 thin melanomas were found to have a positive sentinel lymph node. In melanomas thinner than .75 mm, no positive sentinel lymph node was found. Therefore, only 3% of patients may benefit from tumor upstaging by sentinel lymph node biopsy.Conclusions: The occurrence of regional lymph node metastases in thin melanomas is rather low. Our data suggest that sentinel lymph node biopsy may not justified in patients with melanoma <.75 mm thick.

Significance of dual-basin drainage in patients with truncal melanoma undergoing sentinel lymph node biopsy

BACKGROUND The number of nodal basins and the number of lymph nodes containing regional metastases are important prognostic factors in patients with truncal malignant melanoma. Because the lymphatic drainage pattern of truncal melanoma often includes more than 1 basin, we designed a study to evaluate whether: (1) patients with dual-basin drainage were at an increased risk of lymph node metastases identified by sentinel lymph node (SLN) biopsy; and (2) the histologic status of an individual basin reliably predicted the status of the other draining basin in patients with dual-basin drainage. METHODS The records of 269 consecutive patients with melanoma, who were treated primarily with intraoperative lymphatic mapping and SLN biopsy between 1997 and 2002, were reviewed. Of these patients, 122 had primary truncal melanomas. All patients underwent preoperative lymphoscintigraphy, which established the number and location of draining nodal basins. The chi-square and Fishers exact tests of relevant clinicopathologic factors determined which factors were predictive of the presence of a pathologically positive SLN. RESULTS At least one SLN was identified in all patients. Dual-basin drainage was present in 39 (32%) patients, and a pathologically positive SLN was found in 12 (31%) of these patients. By chi-square and Fishers exact tests, dual-basin drainage was not a significant independent risk factor for the presence of at least 1 pathologically positive SLN (P =.846). Tumor thickness (P <.001), Clark level (P =.003), and tumor ulceration (P =.003) were significant independent risk factors for the presence of at least 1 pathologically positive SLN. SLN pathology in one basin did not predict the histology of the other basin in 7 (18%) of 39 patients with dual-basin drainage. CONCLUSIONS Dual-basin drainage is not independently associated with an increased risk of nodal metastases in patients with truncal melanoma. Because the histologic status of an individual basin did not reliably predict the status of the other draining basins in patients with dual-basin drainage, it is important to adequately identify and completely assess all nodal basins at risk, as defined by lymphoscintigraphy, in patients with truncal melanoma.

Interdisciplinary approach to abdominal Burkitt’s lymphoma

Burkitt’s lymphoma is a high-grade, rapidly growing B-cell neoplasm. It is recognized by its aggressive course, brief median survival, and low rates of long-term survival. The authors discuss the case of a patient who acutely presented with intraabdominal complications from a new onset of Burkitt’s lymphoma. The clinical and pathological features, staging, treatment options, and survival data are reviewed. In addition, the role of surgical intervention is carefully analyzed.