Borgognoni Lorenzo, Susini Pietro, Gerlini Gianni, Brandani Paola, Giannotti Vanni, Sestini Serena
Plastic and Reconstructive Surgery Unit, Regional Melanoma Referral Center and Melanoma & Skin Cancer Unit, Santa Maria Annunziata Hospital, 50012 Florence, Italy.
Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy.
Cancers (Basel). 2024 Dec 23;16(24):4279. doi: 10.3390/cancers16244279.
Sentinel Lymph Node Biopsy (SLNB) aims at identifying clinically occult nodal metastases. It is the standard staging procedure for patients with T1b to T4 primary cutaneous melanoma. Moreover, it is recommended whenever the risk of a positive SLNB is >5%, according to the National Comprehensive Cancer Network Melanoma guidelines. When considering Non-Melanoma Skin Cancer (NMSC), the SLNB could play a role in tumors that mainly spreads via lymphatics, but strong evidence is missing. In this paper, the hot topics and controversies are reviewed; Methods: A PRISMA systematic review was carried out on the PubMed (MEDLINE) library from 2004-2024, searching for studies on SLNB in NMSC; Results: Seventy articles and 6379 patients undergoing SLNB for Squamous Cell Carcinoma (SCC), Merkel Cell Carcinoma (MCC), and Porocarcinoma were included. Overall, the SLNB positivity rate in these NMSCs was 24.4%, with an SNLB detection rate of 97.6%. Specifically, the SLNB positivity rate was 12.3% for high-risk cutaneous SCC, 24.4% for anogenital SCC, 29.3% for MCC, and 30.6% for Porocarcinoma. Most papers concluded that SLNB is safe, feasible, and significant in these malignancies; Conclusions: SLNB should be discussed and offered to every patient with MCC, and it should be discussed and considered in "high risk" SCC and Porocarcinoma for staging and prognostic purposes, aiming to identify a subgroup of patients who may benefit the most from early treatments.
前哨淋巴结活检（SLNB）旨在识别临床上隐匿的淋巴结转移。它是T1b至T4原发性皮肤黑色素瘤患者的标准分期程序。此外，根据美国国立综合癌症网络黑色素瘤指南，只要前哨淋巴结活检阳性风险>5%，就建议进行该检查。在考虑非黑色素瘤皮肤癌（NMSC）时，前哨淋巴结活检可能对主要通过淋巴管转移的肿瘤有作用，但缺乏有力证据。本文对热点问题和争议进行了综述；方法：对2004年至2024年PubMed（MEDLINE）数据库进行PRISMA系统综述，搜索非黑色素瘤皮肤癌前哨淋巴结活检的研究；结果：纳入了70篇文章以及6379例接受鳞状细胞癌（SCC）、默克尔细胞癌（MCC）和汗腺癌前哨淋巴结活检的患者。总体而言，这些非黑色素瘤皮肤癌的前哨淋巴结活检阳性率为24.4%，前哨淋巴结活检检出率为97.6%。具体而言，高危皮肤鳞状细胞癌的前哨淋巴结活检阳性率为12.3%，肛门生殖器鳞状细胞癌为24.4%，默克尔细胞癌为29.3%，汗腺癌为30.6%。大多数论文得出结论，前哨淋巴结活检在这些恶性肿瘤中是安全、可行且有意义的；结论：对于每例默克尔细胞癌患者都应讨论并提供前哨淋巴结活检，对于“高危”鳞状细胞癌和汗腺癌，应出于分期和预后目的进行讨论并考虑，旨在识别可能从早期治疗中获益最大的患者亚组。
