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Background/purpose: Sentinel lymph node biopsy (SLNB) is a standard procedure in the management of clinically node-negative melanoma. However, few studies have been performed on SLNB in Asia, which is an acral melanoma-prevalent area. This study evaluated the clinicopathologic prognostic factors of disease-free survival (DFS) and overall survival (OS) in Taiwanese patients with cutaneous melanoma who received wide excision and SLNB. The prognosis of patients with false-negative (FN) SLNB was also evaluated., Methods: Malignant melanoma cases were reviewed for 518 patients who were treated between January 2000 and December 2011. Of these patients, 127 patients with node-negative cutaneous melanoma who received successful SLNB were eligible for inclusion in the study., Results: The SLNB-positive rate was 34.6%. The median DFS was 51.5 months, and the median OS was 90.9 months at the median follow-up of 36.6 months. Multivariate analysis revealed that patients whose melanoma had a Breslow thickness greater than 2 mm had a significantly shorter DFS than patients whose melanoma had a Breslow thickness of 2 mm or less [hazard ratio (HR), 3.421; p = 0.005]. Independent prognostic factors of OS were a Breslow thickness greater than 2 mm (HR, 4.435; p = 0.002); nonacral melanoma (HR, 3.048; p = 0.001); and an age older than 65 years (HR, 2.819; p = 0.036). During the follow-up period, 13 of 83 SLN-negative patients developed a regional nodal recurrence. The SLNB failure rate was 15.7% and the FN rate was 22.8%. Compared to patients with a true-positive SLNB, patients with FN SLNB had a significantly shorter DFS (p = 0.001) but no significant difference in OS (p = 0.262)., Conclusion: Except for the pathologic subtypes, prognostic factors in Taiwan are similar to those used in other melanoma-prevalent countries. Identifying and closely monitoring patients at risk of nodal recurrence after a negative SLNB is important., (Copyright © 2013. Published by Elsevier B.V.)

Background: Sentinel lymph node (SLN) biopsy can replace axillary lymph node dissection (ALND) in prediction of nodal status in node-negative breast cancer. However, patients presenting with multifocal/multicentric (MF/MC) breast cancer are usually excluded from studies of SLN biopsy. This study evaluated the efficacy of SLN biopsy in patients with MF/MC breast cancer., Methods: Breast cancer patients who underwent preoperative lymphoscintigraphy and SLN biopsy with backup ALND from 2004 to 2006 were retrospectively reviewed. Patients enrolled in this study had clinically node-negative unifocal or MF/MC breast cancer based on final histology. Sentinel node biopsy was performed with a 2-day protocol with intradermal radiocolloid injection on day one and SLN biopsy on day two. Histopathologic parameters and the efficacy of the SLN biopsy were compared between unifocal and MF/MC breast cancers., Results: This study enrolled 158 breast cancer patients; one hundred and thirty-five patients were diagnosed with unifocal and 23 with MF/MC breast cancer. The mean numbers of SLNs retrieved were 1.3 for the unifocal and 1.1 for the MF/MC groups. The identification rate, sensitivity, accuracy, and false-negative rate for unifocal and MF/MC breast cancers were 94.8%, 92.6%, 98.4%, and 7.4%; and 100%, 100%, 100%, and 0%, respectively. No significant differences were observed between the two groups for SLN identification, sensitivity, accuracy, and false-negative rate., Conclusion: Sentinel lymph node biopsy using intradermal radiocolloid injection method is feasible for MF/MC breast cancer.

Background: Sentinel lymph node (SLN) biopsy can identify regional metastases and provides an alternative to axillary dissection that avoids arm morbidity. This investigation assessed the accuracy of SLN biopsy for predicting axillary node status., Methods: A total of 174 clinical node-negative breast cancer patients and 165 SLN biopsies were enrolled. SLN biopsy was performed in a two-day protocol with backup axillary dissection: subdermally injected technetium-99 sulfur colloid to detect and localize SLN on day one; sentinel node harvesting under gamma-counter guidance on day two. Clinicopathological factors were statistically analyzed to assess the accuracy of the SLN biopsy., Results: The SLN was identified in 94.3% (165 of 175) of cases. SLN biopsy had an accuracy of 98.2%, with sensitivity of 93.7%, specificity of 100%, negative predictive value of 97.5% and positive predictive value of 100%. Three SLN negative cases had non-SLN metastasis representing a false-negative rate of 6.3% (3 of 48). Tumor size was the only factor statistically correlated with the accuracy of the SLN biopsy. The diagnostic accuracy for tumors sized 2 cm or below was 100%. Hematoxylin-eosin stain followed by immunohistochemical stain increased the diagnosis of axillary metastasis from 25.5% to 29.1%., Conclusion: SLN biopsy can accurately forecast axillary node status in early breast cancer, particularly in patients with tumor sizes of no more than 2 cm.

Background: Sentinel lymph node (SLN) biopsy in breast cancer is an effective technique with a high degree of accuracy and low false-negative rate to replace axillary lymph node dissection (ALND). This study analyzed the major clinicopathological factors associated with nonvisualized sentinel nodes during preoperative lymphoscintigraphy., Methods: Breast cancer patients who underwent preoperative lymphoscintigraphy and sentinel node biopsy between 2000 and 2003 were retrospectively reviewed. Sentinel node biopsy was performed with a two-day protocol. On day one, a filtered (45 micro m Millipore) technetium-99m sulfur colloid isotope with a mean radioactive dose of 37 MBq (1 mCi) in a diluted volume of 1 ml was injected subdermally just above the primary breast tumor site. Serial dynamic images were taken with a high-resolution collimator and a static image was acquired after the SLN was identified. No hot spot identified two hours after injection was classified as nonvisualization unless lymphatic drainage channels were viewed by the lymphoscintigraphy and a prolonged two hour scan was obtained. Sentinel nodes were harvested on day two. The cases with nonvisualized sentinel nodes were analyzed according to clinical histopathologic parameters to determine the clinical significance., Results: A total of two hundred thirty-two breast cancer patients were enrolled in this study. Twenty-four of these cases presented with advanced breast cancer prior to neoadjuvant chemotherapy. The sentinel node was nonvisualized in twenty-seven of two hundred thrity-two cases (11.6%). Tumor size (p = 0.025) and lymph node metastasis (p = 0.001) were two factors associated with nonvisualized sentinel node in univariate analysis. Multivariate logistic regression analysis showed that more than three nodes (p = 0.001) and more than ten nodes (p = 0.001) metastasis were independent factors associated with nonvisualized sentinel node., Conclusions: Patients with more than three axillary nodes metastasis is an independent factor associated with nonvisualized sentinel node during lymphoscintigraphy.

Background and Purpose: Lymphoscintigraphy has been considered a useful tool for sentinel lymph node (SLN) mapping for malignant melanoma. This study evaluated the usefulness of SLN detection by lymphoscintigraphy and excision with intraoperative gamma probe in Taiwanese patients with malignant melanoma., Methods: Thirty six malignant melanoma patients in clinical stage I and II were enrolled. The Breslow thickness of the primary melanomas was /= 4 mm in 3 patients, and unknown in 4 patients who were transferred from other hospitals and had no nodal or distant metastasis. SLN lymphoscintigraphy was performed with filtered 99mTc-sulfur colloid. An intraoperative gamma probe was used to identify the SLN for dissection., Results: A total of 44 SLNs were detected in 36 patients, with a mean of 1.22 SLNs per patient. The SLN detection rate by lymphoscintigraphy was 100%. During surgery, 39 of the 44 SLNs (88.6%) in 33 of 36 patients (91.7%) were identified. SLN metastasis was found in 8 of 39 dissected SLNs (20.5%) or in 8 of 36 patients (22.2%). The SLN metastatic rate in the patients with primary melanoma with Breslow thickness 2.0 mm was 41.7% (5/12)., Conclusions: Lymphoscintigraphy and intraoperative gamma probe are useful in localizing and dissecting SLN in patients with malignant melanoma. SLN mapping changed the clinical stage in 22.2% of melanoma patients.

Background: Lymphoscintigraphy and sentinel lymph node (SLN) biopsy are highly accurate methods of detecting regional lymph node status for melanoma. Previously, these procedures were mainly performed in patients with primary melanoma before wide local excision., Objective: To present a case with in-transit recurrence melanoma using lymphoscintigraphy and SLN biopsy for detection of nodal basin status., Methods: The patient discussed here had a subungual melanoma that developed as an in-transit metastatic melanoma on the pretibia area 2 years after right big toe amputation. By using lymphoscintigraphy and SLN biopsy technique with injection of technetium-99m colloid around the in-transit metastatic site, the first node (SLN) draining the in-transit metastatic tumor was identified and harvested on the right inguinal area. Immediate right inguinal node dissection was subsequently performed., Results: Under thorough histologic examination, the first node (SLN) draining the in-transit metastatic tumor was the only node that contained micrometastatic tumor cells in the surgical specimens., Conclusion: Lymphoscintigraphy and SLN biopsy techniques are sensitive procedures for detecting the regional nodal basin micrometastasis in in-transit recurrence melanoma patients.

A 51-year-old man presented with lower back skin pigmentation tag that he had had for 2 years. Physical examination showed a 10 x 10 mm ulcerated, protruding pigmented skin mass at the midline of back at the 4th lumbar spine level. Skin biopsy disclosed a 5 mm thickness nodular melanoma, which had invaded the reticular dermis. In addition, a 20 x 20 mm lymph node in the right inguinal region was noted. A pelvic computed tomography scan revealed no definite evidence of lymph node enlargement in the left inguinal, bilateral iliac or para-aortic region. However, the 99mTc-sulfurcolloid dynamic lymphoscintigraphy revealed a sentinel lymph node (SLN) in the left inguinal area. The histological examination of the 4-mm SLN demonstrated a small cluster of metastatic melanoma, which was confirmed using HMB-45 immunohistochemical stain. Meanwhile, no melanoma cells were seen in the right enlarged inguinal lymph node. Subsequently, complete left inguinal lymph node dissection was performed, which confirmed that there was no melanoma metastasis in any of remaining 14 nodes. The patient underwent regular follow-up for 9 months and had no evidence of malignancy recurrence to date.

John Wen-Cheng Chang,1 Yen-Lin Huang,2 Yao-Yu Chang,3 Yung-Feng Lo,4 Tsung-Ying Ho,5 Yi-Ting Huang,6 Huan-Wu Chen,7 Chiao-En Wu1 1Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; 2Department of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; 3Department of Dermatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; 4Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; 5Department of Nuclear Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; 6Department of Radiology Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; 7Department of Medical Imaging & Intervention, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, TaiwanCorrespondence: Chiao-En WuDivision of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, 5, Fushing St., Gueishan Township, Taoyuan 333, TaiwanTel +886-3-328-1200 ext 8825Email jiaoen@gmail.comPurpose: Sentinel lymph node biopsy (SLNB) is the standard management for clinically node-negative cutaneous melanoma patients. This study aimed to evaluate the role of SLNB in Taiwanese melanoma patients and in particular, patients with acral lentiginous melanoma (ALM).Patients and methods: We retrospectively analyzed the clinicopathological characteristics and survival outcomes of the patients who underwent primary surgery followed by either SLNB or nodal observation at the Linkou Chang Gung Memorial Hospital from January 2000 to December 2011.Results: Among the total of 209 patients, 127 underwent SLNB and 51 underwent nodal observation only after primary surgery. There were no significant differences in clinicopathological features between the two groups except that patients who underwent SLNB were older and had a higher rate of ALM than those under nodal observation. The median follow-up time was 43.5 months until July 2013. The patients who underwent SLNB had significantly better disease-free survival (DFS) (57.1 vs 18.7 months, p < 0.01) and melanoma-specific survival (MSS) (112.4 vs 45.2 months, p < 0.01) than those under observation. Improvement in DFS (HR: 0.51, p < 0.01) and MSS (HR: 0.60, p = 0.03) was observed even after adjusting for age and disease pathology by multivariate analysis. This benefit of clinical outcomes persisted in patients with ALM, Breslow thickness ≤2 mm, or no ulceration, but not in patients with non-ALM, Breslow thickness >2 mm, or ulceration.Conclusion: SLNB was associated with favorable outcomes in patients with clinically node-negative cutaneous melanoma, particularly in Taiwanese patients with ALM, Breslow thickness ≤2 mm, and nonulcerated melanoma.Keywords: cutaneous melanoma, sentinel lymph node biopsy, acral lentiginous melanoma, nodal observation