Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma of the lower extremity

Successful management of recalcitrant groin lymphorrhoea with the combination of intraoperative lymphatic mapping and muscle flap

Recalcitrant groin lymphorrhoea in high-risk patients remains a problem. In this report, a cardiac transplant patient with recalcitrant groin lymphorrhoea was successfully treated with a combination of intraoperative lymphatic mapping and sartorius muscle flap. We believe that the combined use of these two treatment options offers a more effective approach for surgical treatment of recalcitrant groin lymphorrhoea and should be considered when managing this difficult clinical problem, especially in high-risk patients.

Superficial femoral lymph node dissection after positive sentinel lymphadenectomy for early-stage melanoma of the lower extremity

The purpose of this study was to evaluate retrospectively the value of a subsequent superficial femoral lymph node dissection for patients with early melanoma of the lower extremity after a positive sentinel lymphadenectomy. During a 6-year period at the H. Lee Moffitt Cancer Center & Research Institute, 16 consecutive patients with clinical stage I or stage II melanoma of the lower extremity underwent subsequent superficial femoral lymph node dissections after positive sentinel lymphadenectomies and wide local excisions of the primary lesions. Fifteen patients (94%) were found to have no additional positive lymph nodes from their superficial femoral lymph node dissection specimens. In contrast, only 1 patient (6%) with a thick primary lesion (7.5 mm) was found to have one additional positive lymph node on a subsequent superficial femoral lymph node dissection. No patients developed any regional nodal recurrences during a mean follow-up of 31.1 months (range, 3-80 months). This preliminary report suggests that the majority of the time the sentinel lymph node may be the only site of regional microscopic nodal disease and that a subsequent superficial femoral lymph node dissection may not be necessary in patients with early melanoma of the lower extremity after a positive sentinel lymphadenectomy. However, whether the sentinel lymphadenectomy can be used solely as a regional surgical treatment for this subgroup of patients still warrants further evaluation.

The new melanoma staging system

The new melanoma staging system from The American Joint Committee on Cancer (AJCC) is described. This major revision includes new criteria for staging the primary tumor (T), metastatic nodes (N) and distant metastases (M) as well as stage groupings. These criteria more accurately reflect those prognostic features of the primary and metastatic melanoma that correlate with survival outcome. Physicians managing melanoma should use this staging system in their clinical practice and in the conduct of melanoma clinical trials.