PROSPECTIVE EVALUATION OF SELECTIVE LYMPH-NODE BIOPSY FOR CUTANEOUS MALIGNANT-MELANOMA

Some patients presenting with cutaneous malignant melanoma without pal pable adenopathy have regional metastatic disease. We have applied the technique of gamma probe-directed selective lymph node biopsy and use d the results to direct further therapy. The results of a prospective nonrandomized clinical study are presented. Between November 1993 and December 1996, 63 patients with a diagnosis of primary cutaneous malig nant melanoma underwent lymphoscintigraphy with technetium sulfur coll oid followed by gamma probe-guided lymph node biopsy. There were 32 (5 1%) women and 31 (49%) men with a mean age of 51.1 years (median, 50; range, 13-87). Mean Breslow thickness was 2.13 mm (range, 0.5-15.0 mm; median, 1.56 mm). Primary locations were head and neck in 8 (13%), tr unk in 24 (38%), upper extremity in 13 (21%), and lower extremity in 1 8 (29%). Selective lymph node biopsy was done on an outpatient basis w ith local anesthesia in 49 cases (78%) and in the operating room with general anesthetic in 14 patients (22%). One lymph node site was biops ied in 46 patients (73%), two sites in 16 (25%), and three in 1 (2%), for a total of 81 selective lymph node biopsy sites, mean 1.29 per pat ient. The mean number of labeled lymph nodes removed per site per pati ent was 1.64 (range, 1-5). Seroma or infection occurred in 6 patients (10%). Micrometastatic disease was identified in nine selective lymph node biopsy sites in eight patients. Of eight patients undergoing lymp h node dissection, 5 (63%) had no additional pathological lymph node i nvolvement. With a mean follow-up of 579 days from selective lymph nod e biopsy (median, 594; range, 36-1157), 59 (94%) have no evidence of d isease. Three patients have died, 2 with systemic disease (475 and 114 9 days) and 1 from a myocardial infarction (380 days). No patient has failed with regional-only recurrence. Gamma probe-directed selective l ymph node biopsy is a straightforward procedure that can be done in th e outpatient setting and facilitates management of patients with cutan eous malignant melanoma.