MELANOMA METASTASES THROUGH THE LYMPHATIC SYSTEM
Section snippets
ROLE OF LYMPH NODE METASTASES IN TUMOR BIOLOGY
Most melanoma patients who develop metastatic spread first develop tumor in the ipsilateral regional lymph nodes. The path of spread is predictable for tumors on the limbs, although tumors occasionally spread first to the popliteal or antecubital nodes rather than to the more usual inguinal or axillary node groups. Drainage from primary melanomas in the head and neck area is less straightforward, and spread to the posterior cervical nodes or across the midline is frequently encountered. Primary
EVALUATION OF THE REGIONAL NODES IN THE ASSESSMENT OF PROGNOSIS
The prognosis for patients with melanoma spread to the regional nodes is worse than that of individuals with melanoma confined to the primary site.5 The amount of tumor present in the nodes and the likely outcome are clearly related. Tumor burden is estimated most easily by identifying the number of nodes that contain melanoma relative to the total number of nodes removed.2, 31 A combination of the number of tumor-positive nodes and the proportion of total lymph node mass that is occupied by
HANDLING AND PATHOLOGIC ANALYSIS OF LYMPH NODES
The effectiveness of the pathologic lymph node analysis is affected by the manner in which lymph node tissues are excised and preserved, and the timeliness with which they are transferred to the pathology laboratory. Surgeons should minimize “crush artefact” and excessive distortion by cautery, and should make sure that specimens are placed immediately after excision in a sufficient quantity of formalin. The most frequent contributions from pathology are analysis of fine needle aspirates, the
DIFFICULTIES IN DIAGNOSIS OF NODAL METASTATIC MELANOMA
Identification and diagnosis are more difficult if a melanoma is amelanotic, if the node contains benign nevocyte aggregates, and in the absence of clinical or historical evidence of a primary melanoma (unknown primary).
SELECTIVE LYMPH NODE DISSECTION
The author discourages the use of frozen sections in the interpretation of sentinel nodes because identification of small numbers of melanoma cells is more accurate in well-fixed and stained sections. Additionally, critical diagnostic tissue is lost during “facing up” of the frozen block and subsequent preparation of the fixed material. The distortion of tissues melted from a frozen block and subsequently fixed requires removal of substantial tissue to achieve a “full-face” section from the
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Standard immunostains for melanoma in sentinel lymph node specimens: Which ones are most useful?
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2002, Seminars in OncologyCitation Excerpt :The overall rate of discordance was 20%. These results suggest that preoperative lymphoscintigraphy is a prerequisite for characterizing the lymphatic drainage pattern in patients with primary melanoma, especially for sites such as the head, neck, and trunk, which frequently drain to multiple basins or multiple SLNs via aberrant pathways.23,50,51 The accuracy of preoperative lymphoscintigraphy has also been demonstrated.
Sentinel lymph node biopsy in melanoma patients
2010, Journal of the European Academy of Dermatology and VenereologyIncreased detection of metastatic melanoma in pediatric sentinel lymph node biopsies using RT-PCR on paraffin-embedded tissue
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Address reprint requests to Alistair J. Cochran, MD, FRCP, UCLA School of Medicine, Department of Pathology and Laboratory Medicine, Box 951713, Los Angeles, CA 90095-1713, e-mail: [email protected]
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Department of Pathology and Laboratory Medicine, University of California Los Angeles School of Medicine, Los Angeles, California