Background
Currently, a sentinel lymph node biopsy is recommended when the Breslow thickness is equal to or greater than 0.8mm and should be considered in other cases on an individual basis. It is estimated that pre-operative imaging fails to identify the sentinel lymph node in 3-7% of cases. Failure to localise the sentinel node can result in a management dilemma with no established guidelines as to how to proceed.
Aim
To estimate the failure rate of pre-operative sentinel node imagining and the subsequent management strategies employed.
Methods
Lymphoscintigram data from patients in Dunedin hospital over a ten-year period was reviewed. Patient demographics and melanoma -specific data was collected. The rate of non-localisation of the sentinel node was calculated and the management strategies employed were examined. In addition, a convenience sample of melanoma surgeons across Australasia and Ireland were invited to complete an online survey to establish international practice when such cases are encountered. The cohort included plastic and reconstructive surgeons, general surgeons and head and neck surgeons respectively. Participants were identified via surgical colleges and professional organisations. The study was approved by the Human Ethics Committee, University of Otago, Dunedin, New Zealand.
Results
The rate of non-localisation of the sentinel node by lymphoscintigram in Dunedin ho:spital was consistent with rates reported internationally. All patients were subsequently managed in the setting of a multidisciplinary meeting and underwent further imaging in addition to the recommended clinical follow-up. Responses to the online survey indicated similar management strategies were employed by melanoma surgeons across Australasia and Ireland.
Conclusion
Currently, there are no evidence-based guidelines as to how to proceed when pre-operative imaging fails to detect a sentinel lymph node in melanoma patients. The results of this study provide valuable information regarding the current practices of melanoma surgeons when faced with this dilemma.