Mistrangelo M, Picciotto F, Quaglino P, Marchese V, Lesca A, Senetta R, Leone N, Astrua C, Roccuzzo G, Orlando G, Bellò M, Morino M
Department of Surgical Sciences, University of Turin, Turin, Italy.
Department of Medical Sciences, University of Turin, Turin, Italy.
Tech Coloproctol. 2025 Jan 3;29(1):38. doi: 10.1007/s10151-024-03086-z.
Anorectal melanoma (ARM) is rare and highly lethal neoplasm. It has a poorer prognosis compared with cutaneous ones. Sentinel lymph node biopsy (SLNB) has become the preferred method of nodal staging method for cutaneous melanoma. The role of SLNB for staging of anal melanoma remains unclear. This study investigates SLN identification and biopsy in patients with ARM.
We present our experience of patients affected by ARM who underwent to SLNB. Clinical workup included digital rectal examination, anoscopy, rigid proctoscopy, total body (computed tomography) CT scan, pelvic magnetic resonance imaging (MRI), and fludeoxyglucose-18-positron emission tomography-CT (FDG-PET-CT) to obtain an adequate pretreatment staging of the patients. Wide local excision and contemporary SLNB were performed to remove primary neoplasm and detect inguinal lymph node metastases.
In total, five female patients, median age 68 years, were included. All were affected by anal melanoma. Detection rate of SLNB was 100% and scintigraphic migration was unilateral in three patients and bilateral in the other two. Definitive inguinal histological exam revealed unilateral metastases in three patients, bilateral metastases in one case, and the presence of isolated neoplastic cells in the remaining case. SLNB allowed a diagnostic upgrading of inguinal metastases in three of five patients (60%), permitting better staging and further appropriate treatment.
Our experience demonstrates SLN biopsy is a minimally invasive, cost-effective, and rapid procedure for accurately staging patients with clinically occult disease. In fact, SLNB emerges as an appropriate procedural tool to identify patients with occult lymph node metastases who could undergo immune or target therapy, as well as to avoid unnecessary inguinal lymph node dissection for patients who would not benefit.
肛管黑色素瘤（ARM）是一种罕见且具有高度致死性的肿瘤。与皮肤黑色素瘤相比，其预后较差。前哨淋巴结活检（SLNB）已成为皮肤黑色素瘤淋巴结分期的首选方法。SLNB在肛管黑色素瘤分期中的作用仍不明确。本研究调查了ARM患者的前哨淋巴结识别和活检情况。
我们介绍了接受SLNB的ARM患者的经验。临床检查包括直肠指检、肛门镜检查、硬式直肠镜检查、全身计算机断层扫描（CT）、盆腔磁共振成像（MRI）以及氟脱氧葡萄糖-18-正电子发射断层扫描-CT（FDG-PET-CT），以对患者进行充分的术前分期。进行了广泛局部切除和同期SLNB，以切除原发性肿瘤并检测腹股沟淋巴结转移情况。
总共纳入了5名女性患者，中位年龄68岁。所有患者均患有肛管黑色素瘤。SLNB的检出率为100%，放射性核素迁移在3例患者中为单侧，在另外2例中为双侧。最终的腹股沟组织学检查显示，3例患者有单侧转移，1例有双侧转移，其余1例有孤立的肿瘤细胞。SLNB使5例患者中的3例（60%）腹股沟转移的诊断得到升级，从而能更好地分期并进行进一步的适当治疗。
我们的经验表明，前哨淋巴结活检是一种微创、经济高效且快速的程序，可准确对临床隐匿性疾病患者进行分期。事实上，SLNB已成为一种合适的程序工具，可识别可能接受免疫或靶向治疗的隐匿性淋巴结转移患者，同时避免对无获益的患者进行不必要的腹股沟淋巴结清扫。
