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Update on lymphatic mapping and sentinel node biopsy in the management of patients with melanocytic tumours
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A population-based validation of the AJCC melanoma staging system
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This provides an excellent commentary on recent large studies demonstrating the role of sentinel node biopsy in the evaluation of cutaneous melanoma
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Balch CM, Cascinelli N. Sentinel node biopsy in melanoma. N Engl J Med 2006; 355:1370-1371. This provides an excellent commentary on recent large studies demonstrating the role of sentinel node biopsy in the evaluation of cutaneous melanoma.
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Balch, C.M.1
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Technical details of intraoperative lymphatic mapping for early stage melanoma
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Melanoma patient staging: Histopathological versus molecular evaluation of the sentinel node
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Scoggins CR, Ross MI, Reintgen DS, et al. Prospective multiinstitutional study of reverse transcriptase polymerase chain reaction for molecular staging of melanoma. J Clin Oncol 2006; 24:2849-2857. A large prospective multicenter study (1446 patients) with histologically negative sentinel nodes used RT-PCR for four different melanoma markers (tyrosinase, MART1, MAGE3, GP-100). There was no difference in disease free or overall survival between RT-PCR positive and RT-PCR negative sentinel lymph nodes. There was a significant decrease in disease free but not overall survival in patients with more than one positive marker by RT-PCR in peripheral blood.
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Scoggins CR, Ross MI, Reintgen DS, et al. Prospective multiinstitutional study of reverse transcriptase polymerase chain reaction for molecular staging of melanoma. J Clin Oncol 2006; 24:2849-2857. A large prospective multicenter study (1446 patients) with histologically negative sentinel nodes used RT-PCR for four different melanoma markers (tyrosinase, MART1, MAGE3, GP-100). There was no difference in disease free or overall survival between RT-PCR positive and RT-PCR negative sentinel lymph nodes. There was a significant decrease in disease free but not overall survival in patients with more than one positive marker by RT-PCR in peripheral blood.
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8
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Detection of melanoma cells in sentinel lymph nodes by reverse transcriptase-polymerase chain reaction: Prognostic significance
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Prognostic significance of occult metastasis detected by sentinel lymphadenectomy and reverse transcriptase-polymerase chain reaction in early-stage melanoma patients
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Bostick PJ, Morton DL, Turner RR, et al. Prognostic significance of occult metastasis detected by sentinel lymphadenectomy and reverse transcriptase-polymerase chain reaction in early-stage melanoma patients. J Clin Oncol 1999; 17:3238-3244.
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Kammula US, Ghossein R, Bhattacharya S, Coit DG. Serial follow-up and the prognostic significance of reverse-transcriptase-polymerase chain reaction-staged sentinel lymph nodes from melanoma patients. J Clin Oncol 2004; 22:3989-3996.
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Mangas C, Hilari JM, Paradelo C, et al. Prognostic significance of molecular staging study of sentinel lymph nodes by reverse transcriptase- polymerase chain reaction for tyrosinase in melanoma patients. Ann Surg Oncol 2006; 13:910-918. A study of 180 patients showed that while 86 of these patients had RT-PCR positivity for tyrosinase in histologically negative sentinel lymph nodes, there was no difference in disease free or overall survival.
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Mangas C, Hilari JM, Paradelo C, et al. Prognostic significance of molecular staging study of sentinel lymph nodes by reverse transcriptase- polymerase chain reaction for tyrosinase in melanoma patients. Ann Surg Oncol 2006; 13:910-918. A study of 180 patients showed that while 86 of these patients had RT-PCR positivity for tyrosinase in histologically negative sentinel lymph nodes, there was no difference in disease free or overall survival.
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12
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Tatlidil C, Parkhill WS, Giacomantonio CA, et al. Detection of tyrosinase mRNA in the sentinel lymph node of melanoma patients is not a predictor of short-term disease recurrence. Mod Pathol 2007; 20:427-434. A study of 139 patients demonstrated that while the presence of a histologically positive sentinel lymph node decreases overall and disease free survival, the presence of an RT-PCR positive (tyrosinase) sentinel lymph node does not affect disease free or overall survival.
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Tatlidil C, Parkhill WS, Giacomantonio CA, et al. Detection of tyrosinase mRNA in the sentinel lymph node of melanoma patients is not a predictor of short-term disease recurrence. Mod Pathol 2007; 20:427-434. A study of 139 patients demonstrated that while the presence of a histologically positive sentinel lymph node decreases overall and disease free survival, the presence of an RT-PCR positive (tyrosinase) sentinel lymph node does not affect disease free or overall survival.
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13
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Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006; 355:1307-1317. This large prospective trial (1269 patients) demonstrated the efficacy of sentinel node biopsy over observation in patients with intermediate thickness (1.2-3.5 mm) cutaneous melanoma. There was a significant decrease in the 5-year survival rate in patients with a positive sentinel lymph node. Furthermore, patients with nodal metastasis had an increased 5-year survival rate when treated by sentinel node biopsy followed by immediate CLND rather than observation and delayed lymph node dissection.
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Morton DL, Thompson JF, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006; 355:1307-1317. This large prospective trial (1269 patients) demonstrated the efficacy of sentinel node biopsy over observation in patients with intermediate thickness (1.2-3.5 mm) cutaneous melanoma. There was a significant decrease in the 5-year survival rate in patients with a positive sentinel lymph node. Furthermore, patients with nodal metastasis had an increased 5-year survival rate when treated by sentinel node biopsy followed by immediate CLND rather than observation and delayed lymph node dissection.
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18
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Sentinel-node biopsy in melanoma: Author reply
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This is a response to questions raised by the previous study [17••
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Morton DL, Cochran AJ, Thompson JF. Sentinel-node biopsy in melanoma: author reply. N Engl J Med 2007; 356:419-420. This is a response to questions raised by the previous study [17••].
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Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma
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Occult tumor cells in the lymph nodes of patients with pathological Stage I malignant melanoma: An immunohistological study
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Roka F, Mastan P, Binder M, et al. Prediction of nonsentinel node status and outcome in sentinel node-positive melanoma patients. Eur J Surg Oncol 2007; 12 Mar [Epub ahead of print] This study of 504 patients demonstrated that none of the current histologic parameters or algorithms evaluating positive sentinel lymph nodes can reliably predict the presence or absence of nonsentinel nodal metastasis. The authors conclude that CLND is still recommended for all patients with positive sentinel lymph nodes.
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Roka F, Mastan P, Binder M, et al. Prediction of nonsentinel node status and outcome in sentinel node-positive melanoma patients. Eur J Surg Oncol 2007; 12 Mar [Epub ahead of print] This study of 504 patients demonstrated that none of the current histologic parameters or algorithms evaluating positive sentinel lymph nodes can reliably predict the presence or absence of nonsentinel nodal metastasis. The authors conclude that CLND is still recommended for all patients with positive sentinel lymph nodes.
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40
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van Akkooi ACJ, de Wilt JHW, Verhoef C, et al. Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol 2006; 17:1578-1585. A study of 74 patients with positive sentinel nodes showed that nodal metastasis is statistically related only to sentinel node tumor burden. Furthermore, there was no nodal metastasis and no decrease in survival in patients with sentinel nodal micrometastasis under 0.1 mm. The authors suggest that these patients may not need CLNDs. We, however, disagree with this conclusion.
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van Akkooi ACJ, de Wilt JHW, Verhoef C, et al. Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative? Ann Oncol 2006; 17:1578-1585. A study of 74 patients with positive sentinel nodes showed that nodal metastasis is statistically related only to sentinel node tumor burden. Furthermore, there was no nodal metastasis and no decrease in survival in patients with sentinel nodal micrometastasis under 0.1 mm. The authors suggest that these patients may not need CLNDs. We, however, disagree with this conclusion.
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Satzger I, Volker B, Al Ghazal M, et al. Prognostic significance of histopathological parameters in sentinel nodes of melanoma patients. Histopathology 2007; 50:764-772. An analysis of 169 positive sentinel nodes showed that increased tumor burden over 2 mm, infiltration of the capsule, and largest tumor deposit over 30 cells all correlate with a poor prognosis.
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