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Nonvisualization of Sentinel Lymph Nodes by Lymphoscintigraphy in Primary Cutaneous Melanoma: Incidence, Risk Factors, and a Review of Management Options

Li, Yunzhu M.D.; Long, Xiao M.D.

Plastic and Reconstructive Surgery: July 2019 - Volume 144 - Issue 1 - p 148e-149e
doi: 10.1097/PRS.0000000000005739
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Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, People’s Republic of China

Correspondence to Dr. Long, Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, People’s Republic of China, pumclongxiao@126.com

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Sir:

We read with great interest the article entitled “Nonvisualization of Sentinel Lymph Nodes by Lymphoscintigraphy in Primary Cutaneous Melanoma: Incidence, Risk Factors, and a Review of Management Options.”1 The retrospective study yielded the incidence and characteristics of melanoma patients with negative lymphoscintigraphic findings and reviewed the management options in such cases.

In the Results section, the authors claimed that of the nine patients whose lymphoscintigraphic and sentinel lymph node biopsy results were negative, four developed recurrent disease and two had distant metastases. Meanwhile, the recurrence rate of the 16 patients with negative lymphoscintigraphy but positive lymph node biopsy results was significantly lower (four of nine versus one of 16; p = 0.04). In addition, none of them developed distant metastases. However, the authors did not give their opinion on this remarkable result. In a study2 on nonvisualization lymphoscintigraphy in advanced breast cancer, they hypothesized that advanced disease might lead to obstructed flow of lymphatics, resulting in nonvisualization of the sentinel lymph node. We assume the explanation would fit melanoma as well because the mechanisms of lymphoscintigraphy on these two tumors are similar. Moreover, the hypothesis is consistent with the worse prognosis of the patients with negative sentinel lymph node biopsy results, allowing the hypothesis to be more persuasive. We would love to know about the perspectives from the authors. Now that we understand the possible association of negative sentinel lymph node biopsy results with worse prognosis, should we “wait and watch” or should we perform completion node dissection in such cases?

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Disclosure

The authors have no financial interest to declare in relation to the content of this communication. There was no funding for this work.

Yunzhu Li, M.D.Xiao Long, M.D.Division of Plastic and Reconstructive SurgeryPeking Union Medical College HospitalBeijing, People’s Republic of China

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REFERENCES

1. Pavri SN, Gary C, Martinez RS, et al. Nonvisualization of sentinel lymph nodes by lymphoscintigraphy in primary cutaneous melanoma: Incidence, risk factors, and a review of management options. Plast Reconstr Surg. 2018;142:527e–534e.
2. Wosnitzer B, Mirtcheva R, Ghesani M. Nonvisualization of sentinel node by lymphoscintigraphy in advanced breast cancer. Radiol Case Rep. 2010;5:444.
Copyright © 2019 by the American Society of Plastic Surgeons