Address of Corresponding Author

Dermatology 2006;212:47-52 (DOI: 10.1159/000089022)

  Key Words

• Melanoma
• Sentinel lymph node biopsy
• Consecutive complete lymph node dissection

  Abstract

Background: Ultrasound (sonography, B-mode sonography, ultrasonography) examination improves the sensitivity in more than 25% compared to the clinical palpation, especially after surgery on the regional lymph node area. Objective: To evaluate the distribution of metastases during follow-up in the draining lymph node areas from the scar of primary to regional lymph nodes (head and neck, supraclavicular, axilla, infraclavicular, groin) in patients with cutaneous melanoma with or without sentinel lymph node biopsy (SLNB) or former elective or consecutive complete lymph node dissection in case of positive sentinel lymph node (CLND). Methods: Prospective multicenter study of the Departments of Dermatology of the Universities of Homburg/Saar, Tübingen and Munich (Germany) in which the distribution of lymph node and subcutaneous metastases were mapped from the scar of primary to the lymphatic drainage region in 53 melanoma patients (23 women, 30 men; median age: 64 years; median tumor thickness: 1.99 mm) with known primary, visible lymph nodes or subcutaneous metastases proven by ultrasound and histopathology during the follow-up. Results: Especially in the axilla, infraclavicular region and groin the metastases were not limited to the anatomic lymph node regions. In 5 patients (9.4%) (4 of them were in stage IV) lymph node metastases were not located in the corresponding lymph node area. 32 patients without former SLNB had a time range between melanoma excision and lymph node metastases of 31 months (median), 21 patients with SLNB had 18 months (p < 0.005). In 11 patients with positive SLNB the time range was 17 months, in 10 patients with negative SLNB 21 months (p < 0.005); in 32 patients with CLND the time range was 31 months and in 21 patients without CLND 18 months (p < 0.005). In thinner melanomas lymph node metastases occurred later (p < 0.05). Conclusions: After surgery of cutaneous melanoma, SLNB and CLND the lymphatic drainage can show significant changes which should be considered in clinical and ultrasound follow-up examinations. Especially for high-risk melanoma patients follow-up examinations should be performed at intervals of 3 months in the first years. Patients at stage IV should be examined in all regional lymph node areas clinically and by ultrasound.

Copyright © 2006 S. Karger AG, Basel

  Author Contacts

Andreas Blum, MD
Private and Teaching Practice of Dermatology
Seestrasse 3a
DE-78464 Konstanz (Germany)
Tel. +49 7531 64311, Fax +49 7531 60054, E-Mail a.blum@derma.de

  Article Information

Andreas Blum and Monika-Hildegard Schmid-Wendtner contributed equally to this work.

Received: November 29, 2004
Accepted: May 6, 2005
Number of Print Pages : 6
Number of Figures : 3, Number of Tables : 3, Number of References : 16