Pathologic evaluation of regional lymph nodes in melanoma
- April W Armstrong, MD, MPH
April W Armstrong, MD, MPH
- Associate Dean for Clinical Research
- Department of Dermatology
- University of Southern California
- Vincent Liu, MD
Vincent Liu, MD
- Clinical Professor
- Departments of Dermatology and Pathology
- University of Iowa Carver College of Medicine
- Martin C Mihm, Jr, MD
Martin C Mihm, Jr, MD
- Clinical Professor of Pathology
- Harvard Medical School
- Brigham and Women's Hospital
- Section Editors
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms; Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
- Hensin Tsao, MD, PhD
Hensin Tsao, MD, PhD
- Section Editor — Melanocytic Lesions and Disorders of Pigmentation
- Professor of Dermatology
- Harvard Medical School
Cutaneous melanoma characteristically spreads via the lymphatic system from its primary site to the locoregional lymph nodes. Knowledge of lymph node status is important for prognosis and to determine the appropriateness of adjuvant systemic therapy.
The identification of patients with subclinical nodal metastases has undergone significant evolution over the past two decades. For patients for whom there is a reasonable risk of regional lymph node metastasis (melanomas >1 mm in thickness and certain thinner melanomas, especially those with ulceration or >1 mitosis/mm2), lymphatic mapping with sentinel lymph node (SLN) biopsy has become the standard staging approach . If melanoma metastasis is present in the SLN, a completion lymphadenectomy is usually recommended and adjuvant therapy considered. (See "Evaluation and treatment of regional lymph nodes in melanoma", section on 'Sentinel lymph node biopsy'.)
The pathologic evaluation of regional lymph nodes is discussed in this topic. The role of sentinel lymph node biopsy and the management of patients with a positive sentinel lymph node are discussed separately, as is the pathology of the primary lesion. (See "Evaluation and treatment of regional lymph nodes in melanoma" and "Pathologic characteristics of melanoma".)
However, both serial sectioning and immunohistochemical staining for melanoma-associated tumor markers (eg, the highly sensitive S100 and the highly specific MART-1) facilitate the detection of metastatic melanoma cells (picture 2). In one retrospective study of 235 histologically negative sentinel lymph nodes (SLNs) from 94 patients with cutaneous melanoma, deeper serial sections and immunohistochemical stains detected microscopic metastases in approximately 12 percent of cases that would otherwise have been reported as negative for metastasis .
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