Metastases in patients with malignant melanoma despite of negative sentinel lymph node: Has the concept to be changed?

Aim: The Sentinel lymph Node (SLN) is of considerable prognostic relevance, because extended lymph node dissection may not be performed in patients pr esenting with histologically negative SIN. The aim of the present study was to prove the prognostic value of the SLN-concept in these patients. Method s: So far the clinical follow-up of 162 patients with histologically proven malignant melanoma and metastatically uninvolved (negative) SIN was invest igated. Histological examination included standard methods (HE-Test) and sp ecial histochemical techniques (S-100, HMB-45). All patients underwent clin ical examination, ultrasonic diagnosis of the regional lymph nodes, and x-r ay of the chest every 3 months. Results. Despite of negative SIN-findings i n 8/162 patients metastases of the malignant melanoma were found after a ti me period of 5-27 months. Three patients presented with recurrence in the p reviously mopped (negative) SLN-basin. In another case the scintigraphicall y visualized SLN could not be identified intraoperatively by means of the h and-held gamma probe. One patient showed intransit-metastases or skin-metas tases, respectively; another patient recurred in the scar area. One patient showed hematogenic dissemination (liver) which is not detectable by lympho scintigraphy; in another patient metastases were found outside the primary lymphatic basin (cervical). Conclusion: In our patient group 4,9% presented with metastases despite negative SLN while published data report up to 11% (observation period 35 months), among them only 3 patients (1,9%) being re al concept failures. Our results underline that there is no evidence to cha nge this concept in patients with clinically early stage.