Melanoma Nodal Disease Can Be Unpredictable

Disease can occur at unpredictable sites, but less commonly than sentinel node biopsy suggests

THURSDAY, Sept. 28 (HealthDay News) -- Patients with melanoma, particularly of the trunk, may have nodal disease at unexpected sites due to unpredictable patterns of lymphatic drainage, according to the results of a study published in the Journal of Plastic, Reconstructive & Aesthetic Surgery. However this may not happen as often as suggested by lymphoscintigraphy studies, which suggest that 25 percent to 34 percent of disease sites may occur in unexpected nodes.

Taimur Shoaib, M.B., Ch.B., and colleagues at the Glasgow Royal Infirmary in the U.K., examined 237 case records of patients with melanoma who had adopted a "wait and see" approach to regional lymph node dissection and who eventually did undergo lymph node removal due to metastasis. The head and neck area was the primary lesion site in 21 percent of cases, the trunk in 31 percent, the upper limbs in 11 percent and the lower limbs in 37 percent.

In 6 percent of cases, the first recurrent metastatic nodal lesions were in unexpected sites. Of these, two cases had primary lesions in the head and neck, 11 in the trunk, and one each in the upper and lower limbs. Sixteen percent of cases (37), had subsequent nodal recurrences in unpredictable sites.

"We suggest that patients with trunk melanomas who are undergoing follow-up, particularly after a lymph node dissection, require examination of all major lymph node groups to identify the 13 to 36 percent of unpredictable sites to which metastasis may occur," the authors conclude.

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