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Pathologic evaluation of regional lymph nodes in melanoma

Authors
April W Armstrong, MD, MPH
Vincent Liu, MD
Martin C Mihm, Jr, MD
Section Editors
Michael B Atkins, MD
Hensin Tsao, MD, PhD
Deputy Editor
Michael E Ross, MD

INTRODUCTION

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 [1]. If melanoma metastasis is present in the SLN biopsy, 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 SLN biopsy and the management of patients with a positive SLN biopsy 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".)

TECHNIQUE

Specimen preparation with hematoxylin and eosin (H&E) staining remains the gold standard for histologic interpretation of nodal material (picture 1) [2].

However, both serial sectioning and immunohistochemical staining for melanoma-associated tumor markers (eg, the highly sensitive S100 and the highly specific melanoma antigen recognized by T cells 1 [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 [3].

           
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Literature review current through: Nov 2017. | This topic last updated: Nov 28, 2017.
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