Su Lyndon D, Fullen Douglas R, Lowe Lori, Wang Timothy S, Schwartz Jennifer L, Cimmino Vincent M, Sondak Vernon K, Johnson Timothy M
Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan48109-0602, USA.
Cancer. 2004 Feb 1;100(3):598-604. doi: 10.1002/cncr.11947.
Desmoplastic and neurotropic melanoma (DNMM) occasionally metastasizes to regional lymph nodes and extranodal sites. The value of sentinel lymph node biopsy (SLNB) has not been demonstrated clearly for patients with DNMM. The authors report on the utility of SLNB in the management of patients with DNMM.
The authors identified 33 patients with DNMM who were seen during a 5-year period in their institution who underwent lymphatic mapping and SLNB. Clinical and histopathologic data were reviewed.
Thirty-three patients with DNMM underwent SLNB (mean Breslow depth, 4.0 mm; median, 2.8 mm). There were 25 male patients and 8 female patients with a median age of 61 years (range, 31-86 years). Fifty-two percent of tumors presented in the head and neck region, and 24% were associated with lentigo maligna. Four of 33 patients (12%) without clinical evidence of metastatic disease who underwent SLNB had at least 1 positive sentinel lymph node. No additional positive lymph nodes were found in subsequent therapeutic regional lymphadenectomy in any of these four patients.
SLNB detected subclinical metastases of DNMM to regional lymph nodes. SLNB at the time of resection can provide useful information to guide early treatment and, coupled with lymphadenectomy in positive patients, may limit tumor spread and prevent recurrence at the draining lymph node basin.
促纤维增生性和嗜神经性黑色素瘤（DNMM）偶尔会转移至区域淋巴结和结外部位。前哨淋巴结活检（SLNB）对DNMM患者的价值尚未得到明确证实。作者报告了SLNB在DNMM患者管理中的效用。
作者确定了33例在其机构5年期间就诊的DNMM患者，这些患者接受了淋巴绘图和SLNB。回顾了临床和组织病理学数据。
33例DNMM患者接受了SLNB（平均Breslow深度，4.0mm；中位数，2.8mm）。有25例男性患者和8例女性患者，中位年龄61岁（范围，31 - 86岁）。52%的肿瘤出现在头颈部区域，24%与恶性雀斑样痣相关。33例无转移疾病临床证据且接受SLNB的患者中有4例（12%）至少有1个前哨淋巴结阳性。在这4例患者中的任何一例后续治疗性区域淋巴结清扫术中均未发现额外的阳性淋巴结。
SLNB检测到DNMM向区域淋巴结的亚临床转移。切除时进行SLNB可为早期治疗提供有用信息，并且对于阳性患者结合淋巴结清扫术，可能会限制肿瘤扩散并防止引流淋巴结区域复发。
