The rational of Cloquet lymph node as a sentinel lymph node in iliac dissection in lower limb melanoma

Abstract

Background and aims Intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) is a growingly popular operating procedure for staging regional lymph nodes in early-stage melanoma. The groin is a promising area for this method since superficial groin dissection and iliac dissection have a significant risk of morbidity. There is currently no consensus on how best to treat cases with tumor-positive sentinel lymph nodes (SNs) during surgery involving these basins. Methods A total of 182 cases were treated using the LM/SL method. There was consistent detection of sentinel lymph nodes. SN dissection was performed on patients who had tumor in their SN. A hematoxylin and eosin stain was used to analyze the sentinel lymph nodes. Patient selection for SN dissection was based only on the presence of tumor in that node. Computerized database containing log-rank tests and Cox regression models for statistical analysis. Results 61% of the 182 cases were female, with an average age of 50 (range, 15–89). Tumor-positive SNs were detected in 21% of cases. 67% of cases were identified to have sentinel full lymph node dissection and a single tumor-positive lymph node after LM/SL, whereas 27% had 2 tumor-positive lymph nodes and 6% had 3 or more tumor-positive lymph nodes. Recurrence in the dissected basin occurs in just 4% of individuals with tumor-negative SNs. Cases whose lymph nodes tested negative for tumors had a significantly greater 5-year overall survival (mean±SD, 94% 5%) compared with those whose lymph nodes tested positive for tumors (meanSD, 75% 4%; P 0.01). Primary tumor thickness (P = 0.03), Tumor-positive SN (P 0.001) and ulceration (P = 0.001) were revealed to be important indicators of survival in multivariate studies using a Cox regression model. Conclusions This surgical treatment ought to become common for cases with early-stage melanoma of the lower extremities and trunk because the accuracy of LM/SL as judged by the infrequent recurrences implies that it should. When a tumor-positive SN is found in the groin, it is important to take a sample from the Cloquet node so that one may decide whether or not an iliac dissection is necessary.