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Accuracy of sentinel lymph node dissection for melanoma staging in the presence of a collision tumour with a lymphoproliferative disease

Gero, Daniela; Queiros da Mota, Vanessab; Boubaker, Arianec; Berthod, Gregoired; de Leval, Laurenceb; Demartines, Nicolasa; Matter, Mauricea,d

doi: 10.1097/CMR.0000000000000098
ORIGINAL ARTICLES: Clinical research

Sentinel lymph node dissection (SLND) identifies melanoma patients with metastatic disease who would benefit from radical lymph node dissection (RLND). Rarely, patients with melanoma have an underlying lymphoproliferative disease, and melanoma metastases might develop as collision tumours in the sentinel lymph node (SLN). The aim of this study was to measure the incidence and examine the effect of collision tumours on the accuracy of SLND and on the validity of staging in this setting. Between 1998 and 2012, 750 consecutive SLNDs were performed in melanoma patients using the triple technique (lymphoscintigraphy, gamma probe and blue dye). The validity of SLND in collision tumours was analysed. False negativity was reflected by the disease-free survival. The literature was reviewed on collision tumours in melanoma. Collision tumours of melanoma and chronic lymphocytic leukaemia (CLL) were found in two SLN and in one RLND (0.4%). Subsequent RLNDs of SLND-positive cases were negative for melanoma. The patient with negative SLND developed relapse after 28 months with an inguinal lymph node metastasis of melanoma; RLND showed collision tumours. The literature review identified 12 cases of collision tumours. CLL was associated with increased melanoma incidence and reduced overall survival. This is, to our knowledge, the first assessment of the clinical value of SLND when collision tumours of melanoma and CLL are found. In this small series of three patients with both malignancies present in the same lymph node basin, lymphocytic infiltration of the CLL did not alter radioisotope uptake into the SLN. No false-negative result was observed. Our data suggest the validity of SLND in collision tumours, but given the rarity of the problem, further studies are necessary to confirm this reliability.

Departments of aVisceral Surgery

bPathology

cNuclear Medicine

dOncology, Melanoma Clinic, University Hospital of Lausanne (CHUV), Lausanne, Switzerland

The paper was presented as a poster at the Paris Melanoma Conference, 2–3 May 2013.

Correspondence to Maurice Matter, MD, Department of Visceral Surgery, University Hospital of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland Tel: +41 795 561 071; fax: +41 213 142 851; e-mail: maurice.matter@chuv.ch

Received October 23, 2013

Accepted May 8, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins