Short-term and long-term results of sentinel lymph node biopsy in patients with localized cutaneous melanoma

Introduction. Primary tumor excision is a simple, commonly used and relatively effective treatment for localized cutaneous melanoma (CM). However, in 19-24% of cases, regional lymph node recurrence occurs after excision due to the presence of micrometastases in lymph nodes at the moment of treatment of the primary tumor. Sentinel lymph node (SLN) biopsy is the only reliable method for identifying micrometastatic disease in the regional nodes. Despite the rapid acceptance of SLN biopsy into clinical practice, many controversies remain according to recent literature.

The purpose of this study was to assess short-term and long-term results of SLN biopsy in patients with clinically localized CM using a domestic radiopharmaceutical and equipment.

Materials and methods. This study enrolled 847 consecutive patients with clinically localized CM (any сТ, N0, M0) who were divided into three groups. Group I included 212 patients treated with wide excision alone for CM. Group II included 241 patients who received wide excision for CM followed by one-stage preventive lymphadenectomy. Group III included 394 patients who underwent wide excision for CM and SLN biopsy. SLN localization was performed with the domestic radiopharmaceutical ^99mTc-Technephyt. Intraoperative SLN mapping was undertaken using the domestic handheld gamma detection probe (RADICAL).

Results. In patients with CM <1 mm in thickness, the overall rate of regional lymph node metastasis was 5.9% in group I, 6.9% in group II and 4.7% in group III. The low incidence of regional lymph node metastasis did not require an urgent need for additional methods of regional control in these patients. The five- and seven-year recurrence-free survival rates were 82.4±5.7% and 82.4±5.7% in group I, 90.9±6.2% and 90.9±6.2% (p=0.080) in group II, and 90.8±5.2% and 90.8±5.2% in group III (p=0.106 and p=0.795, respectively). In patients with thin CM, the disease-specific actuarial survival rates were 87.3±5.4% and 87.3±5.4% in group I, there were no deaths during follow-up periods in group II (p=0.030), and 96.9±2.1% and 89.5±7.4 in group III (p=0.514 and p=0.151, respectively). In patients with CM >1 mm thick, the overall rate of regional lymph node metastasis was 24.4% in group I, 25.9% in group II and 29.1% in group III. In group I, regional recurrence occurred. In group II, preventive lymphadenectomy revealed lymph node micrometastasis in 11.3% of cases and regional recurrence in intact lymph nodes in 14.6% of cases, whereas in group III, SLN biopsy revealed lymph node micrometastasis in 23.9% of cases and regional recurrence in intact lymph nodes in 5.2% of cases (p=0.000). The regional recurrence rates were significantly lower in groups II and III than in group I treated with primary melanoma excision alone (p=0.047 and p=0.000, respectively). Remarkably, when lymph nodes were involved, the incidence rates of in-transit melanoma metastases remained stable and did not depend on time and technique for the detection of nodal metastases. So, in-transit metastases occurred in 21.1% of patients with lymph node recurrence in group I, in 20.8% of patients with lymph node micrometastasis in group II, and in 20.3% of patients with SLN micrometastasis in group III versus 3.4-5.1% of patients without lymph node involvement (p=0.000). The five- and seven-year recurrence-free survival rates in CM >1 mm thick were 51.9±4.4% and 48.8±4.5% in group I, 54.9±3.7% and 51.0±3.8% in group II (p=0.648) versus 71.0±3.3% and 64.4±4.8% in group III (p=0.009 and p=0.033, respectively). The disease-specific actuarial survival rates were 63.5±4.3% and 58.1±4.6% in group I, 69.4±3.5% and 63.4±3.8% in group II (p=0.405) versus 86.0±3.0% and 86.0±3.0% in group III (p=0.000 and p=0.000, respectively).

Conclusion. SLN biopsy for CM is minimally invasive and highly accurate in identifying occult nodal disease. It enables to improve short-term and long-term treatment outcomes in patients with CM >1 mm thick. The use of the domestic radiopharmaceutical and equipment makes SLN biopsy highly reproducible and more easily accessible.

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