Cancer Crystal Balls

Melanoma lymph node metastasis can predict survival

(RxWiki News) Lymph nodes appear throughout the body to help fend off invaders. When cancer cells enter lymph nodes, lymph vessels can carry the cancer to other parts of the body. That’s why doctors examine the lymph nodes closest to the tumor — the sentinel lymph nodes — to check for the presence of cancer.

New research has found that when cancer spread beyond the sentinel lymph nodes, patients with stage III melanoma had a worse outlook.

As a result, the authors of this study have suggested that when cancer has spread to non-sentinel lymph nodes, it could be a sign of more severe melanoma.

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For this research, Anna M. Leung MD, of the John Wayne Cancer Institute at Saint John’s Health Center in Santa Monica, California, and colleagues sought to study whether disease that had spread beyond the sentinel lymph nodes would predict decreased survival.

Sentinel lymph node (SLN) biopsies remove tissue from the lymph nodes closest to the tumor to look for cancer.

In melanoma, if cancer has spread, all the nearby lymph nodes are removed to look for the cancer. This procedure is known as completion lymph node dissection (CLND).

For this study, the researchers identified 4,223 melanoma patients from the database at the John Wayne Cancer Institute who had SLN biopsies between 1986 and 2012.

Cancer was found in the of 329 patients. The vast majority of these patients had no additional positive lymph nodes, meaning cancer was not found in any other lymph nodes in the majority of patients. However, 79 patients had cancer in the non-sentinel lymph nodes (NSLN).

Patients who had wider metastasis (spread of cancer) tended to be older, have thicker tumors and have ulceration (inflammation of the tumor).

Average overall survival of patients who only had SLN metastasis was 178 months, compared to 42.2 months for NSLN-positive patients.

The five-year overall survival was 72.3 percent for those whose cancer had spread to the SLNs and 46.4 percent for those whose cancer had spread beyond the SLNs.

Victoria Sharon, MD, DTMH, assistant professor of Dermatology and Dermatologic Surgery and director of Dermatology Inpatient Consultation at University of California, Davis, told dailyRx News, “This study suggests that both positive sentinel and non-sentinel lymph node biopsies may identify a group of individuals within the spectrum of advanced melanoma who are at a higher risk of death compared to patients with only positive sentinel lymph node biopsies.”

This study was published July 31 in the journal JAMA Surgery.

The research was supported by fellowship funding from the Harold McAlister Charitable Foundation and the National Cancer Institute. No conflicts of interest were disclosed.

Review Date: 
July 31, 2013