Secondary lymph node involvement from primary cutaneous large B-cell lymphoma of the leg - Sentinel lymph nodectomy as a new strategy for staging circumscribed cutaneous lymphomas

BACKGROUND. Primary cutaneous large B-cell lymphoma of the leg (LBCLL) is a recently defined type of non-Hodgkin's lymphoma. It forms a separate categ ory in the new classification of primary cutaneous lymphomas elaborated by the European Organization for Research and Treatment of Cancer. It is assoc iated with a less favorable prognosis than the most frequently occurring ty pes of primary cutaneous B-cell lymphoma. METHODS. The authors present four patients with the typical clinicopatholog ic constellation of LBCLL. Three of them died during the pears 1993-1996. T he authors reviewed their courses. The fourth patient was staged by sentine l lymph nodectomy (SLNE), i.e., the selective surgical removal and histolog ic examination of the first draining lymph node associated with the cutaneo us tumor. RESULTS. The courses of the three previous patients were characterized by s econdary involvement of regional lymph nodes followed by systemic dissemina tion of the lymphoma in a third step. Although the conventional staging of the fourth patient had been negative for any extracutaneous lymphoma manife station, the SLNE revealed initial regional lymph node involvement, which h ad decisive implications for the choice of therapy. CONCLUSIONS. SLNE may gain a prominent role in the staging of circumscribed cutaneous lymphomas, in addition to its already established position in me lanoma management. Further positive effects of SLNE are 1) better distincti on of primary cutaneous lymphomas with secondary lymph node involvement fro m primary lymph node lymphomas with skin manifestation, and 2) better insig ht into the biology of different primary cutaneous lymphoma types. Cancer 1 999;85:199-207. (C) 1999 American Cancer Society.