Recurrent melanoma treatment may be directed by biopsy results

The authors aimed to determine whether sentinel lymph node biopsy was effective in detecting and determining treatment in recurrent melanoma. 

Locally recurrent (cancer that returns at or near primary site) or in-transit (cancer found on a skin site on the way to a lymph node) melanoma is a concern in melanoma patients as it can result in distant metastatic disease (cancer spreads to other organs).

Sentinel lymph nodes are the first lymph nodes (site that holds immune cells) that cancer spreads to from the primary tumor. Sentinel lymph node biopsies (SLNB) (sample of tissue is removed and examined under a microscope) can be used to determine the stage of cancer in the body.

Other forms of recurrent melanoma treatment include isolated limb infusion which isolates blood flow to the site of disease to allow for a more concentrated chemotherapy and hypothermic isolated limb perfusion (HILP) which delivers targeted treatment to the site of disease to decrease damage caused to the rest of the body.

The aim of this study was to determine whether SLNB could be used to identify and determine treatment options in recurrent melanoma.

33 patients were used in this study. Follow-up time was every 3 months for 1 year, every 6 months for 5 years and yearly thereafter. The average time from initial diagnosis until local recurrence or in-transit melanoma was 25.7 months.

29 patients had in-transit melanoma and 4 patients had locally recurrent melanoma. 18 patients with more than 5 recurrent lesions underwent removal of lesions as a result of SLNB. 30 patients out of 31 (97%) underwent the removal of at least 1 infected node and from the 30 patients who had a sentinel lymph node removed, 33%  nodes showed metastatic in-transit or locally recurrent melanoma.

Patients were put into 4 categories ; SLNB negative and known cancer removed (12 patients – 2 developed recurrence and needed treatment), SLNB negative and no cancer removed (8 patients – all 8 were treated with isolated limb infusion), SLNB positive and known cancer removed (4 patients – all 4 received complete nodal dissection (removal of lymph node)) and SLNB positive and no cancer removed (6 patients – 3 underwent nodal dissection, 2 received HILP).

Patients who had a positive SLNB at discovery of in-transot melanoma or local recurrence had considerably less time to development of metastatic disease compared to those with a negative SLNB.

The study concluded that sentinel lymph node biopsy is feasible in in-transit or recurrent melanoma, and may be used to predict disease outlook or direct treatment options.

The small number of patients and follow-up time in this study need further validation in larger populations. 

If you are considering a sentinel lymph node biopsy and require further information on the benefit in melanoma please contact your doctor.