The Orderly Progression of Melanoma Nodal Metastases

作者：Douglas S. Reintgen, C. Wayne Cruse, Karen E. Wells, Claudia G. Berman, Neil Alan Fenske, Frank Glass, Kenneth R. Schroer, Richard F. Heller, Merrick I. Ross, Gary H. Lyman, Charles E. Cox, David Rappaport, Seigler Hf, Charles M. Balch · 发表于：Annals of Surgery · 年份：1994 · DOI：10.1097/00000658-199412000-00009 · 被引用次数：742 · 研究领域：Cutaneous Melanoma Detection and Management、Nonmelanoma Skin Cancer Studies、Melanoma and MAPK Pathways

OBJECTIVE: The aim of this study was to determine the order of melanoma nodal metastases. SUMMARY BACKGROUND DATA: Most solid tumors are thought to demonstrate a random nodal metastatic pattern. The incidence of skip nodal metastases precluded the use of sampling procedures of first station nodal basins to achieve adequate pathological staging. Malignant melanoma may be different from other malignancies in that the cutaneous lymphatic flow is better defined and can be mapped accurately. The concept of an orderly progression of nodal metastases is radically different than what is thought to occur in the natural history of metastases from most other solid malignancies. METHODS: The investigators performed preoperative and intraoperative mapping of the cutaneous lymphatics from the primary melanoma in an attempt to identify the "sentinel" lymph node in the regional basin. All patients had primary melanomas with tumor thicknesses > 0.76 mm and were considered candidates for elective lymph node dissection. The sentinel lymph node was harvested and submitted separately to pathology, followed by a complete node dissection. The null hypothesis tested was whether nodal metastases from malignant melanoma occurred in equal proportions among sentinel and nonsentinel nodes. RESULTS: Forty-two patients met the criteria of the protocol based on prognostic factors of their primary melanoma. Thirty-four patients had histologically negative sentinel nodes, with the rest of the nodes in the bas...