Lymphatic flow is mostly preserved after sentinel lymph node biopsy in primary cutaneous malignant melanoma

Kenji Yokota; Masaki Sawada; Takaaki Matsumoto; Yoshie Hasegawa; Michihiro Kono; Masashi Akiyama

doi:10.1016/j.jdermsci.2015.02.011

Lymphatic flow is mostly preserved after sentinel lymph node biopsy in primary cutaneous malignant melanoma

J Dermatol Sci. 2015 May;78(2):101-7. doi: 10.1016/j.jdermsci.2015.02.011. Epub 2015 Feb 25.

Authors

Kenji Yokota¹, Masaki Sawada¹, Takaaki Matsumoto¹, Yoshie Hasegawa¹, Michihiro Kono¹, Masashi Akiyama²

Affiliations

¹ Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: makiyama@med.nagoya-u.ac.jp.

PMID: 25771166
DOI: 10.1016/j.jdermsci.2015.02.011

Abstract

Background: Knowledge of changes in lymphatic flow after sentinel lymph node biopsy (SLNB) is important for the development of strategies for postoperative adjuvant therapy in malignant melanoma.

Objectives: 41 patients (22 males and 19 females; average age: 67.0 ± 24.0 years) with primary cutaneous malignant melanoma (PCMM) participated in the present study. The primary tumor sites were the upper extremities (9 patients), the lower extremities (20 patients), the trunk (11 patients) and the scalp (1 patient). The tumor thicknesses of the PCMM lesions were from 0.5mm to 9.0mm (average: 3.3 ± 2.5mm). All the participants underwent wide local excision and SLNB.

Methods: We studied lymphatic flow before and after SLNB by near-infrared (NIR) imaging in all 41 cases. In addition, we performed NIR imaging of lymphatic flow after the lymph node dissection in one case with sentinel lymph node (SLN) metastasis.

Results: Almost no changes in lymphatic flow were seen in 38 of the 41 patients (92.7%) after SLNB. Only in 3 patients (7.3%), one with SLN metastasis and the other two without SLN metastasis, was apparent alteration in the lymphatic flow observed after SLNB. Of the 16 patients without SLN metastasis, only 3 patients showed recurrence of the tumors. Interestingly, 1 of the 2 patients without SLN metastasis but with lymphatic flow alteration had recurrence (regional lymph node metastasis) of the melanoma, whereas only 2 of the 14 patients without SLN metastasis or lymphatic flow alteration had recurrence, 1 with regional lymph node metastasis and the other with distant lymph node metastasis. In 1 case, we re-examined the lymphatic flow after regional lymph node dissection and the lymphatic flow was found to be dramatically changed.

Conclusion: We clearly demonstrated that SLNB has only a minimal effect on lymphatic flow. The present results suggest that SLNB does not increase the risk of local recurrence/in-transit metastasis and may support the efficacy of post-SLNB local adjuvant injection to prevent local recurrence and in-transit metastasis.

Keywords: Adjuvant therapy; Interferon; Lymphatic flow; Malignant melanoma; Near-infrared; Sentinel lymph node.

MeSH terms

Adult
Aged
Aged, 80 and over
Antineoplastic Agents / therapeutic use
Chemotherapy, Adjuvant
Diagnostic Imaging / methods
Female
Humans
Interferon-beta / therapeutic use
Lymph Node Excision
Lymph Nodes / pathology*
Lymph Nodes / surgery
Lymphatic Metastasis
Lymphatic Vessels / physiopathology*
Male
Melanoma / secondary*
Melanoma / therapy
Middle Aged
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / physiopathology*
Postoperative Period
Preoperative Period
Sentinel Lymph Node Biopsy*
Skin Neoplasms / pathology*
Skin Neoplasms / therapy

Substances

Antineoplastic Agents
Interferon-beta