Ultrasound mapping of lymph node and subcutaneous metastases in patients with cutaneous melanoma: Results of a prospective multicenter study

Background: Ultrasound (sonography, B-mode sonography,
ultrasonography) examination improves the sensitivity in more than
25% compared to the clinical palpation, especially after surgery on
the regional lymph node area. Objective: To evaluate the
distribution of metastases during follow-up in the draining lymph
node areas from the scar of primary to regional lymph nodes ( head
and neck, supraclavicular, axilla, infraclavicular, groin) in
patients with cutaneous melanoma with or without sentinel lymph
node biopsy (SLNB) or former elective or consecutive complete lymph
node dissection in case of positive sentinel lymph node (CLND).
Methods: Prospective multicenter study of the Departments of
Dermatology of the Universities of Homburg/Saar, Tubingen and
Munich (Germany) in which the distribution of lymph node and
subcutaneous metastases were mapped from the scar of primary to the
lymphatic drainage region in 53 melanoma patients ( 23 women, 30
men; median age: 64 years; median tumor thickness: 1.99 mm) with
known primary, visible lymph nodes or subcutaneous metastases
proven by ultrasound and histopathology during the follow-up.
Results: Especially in the axilla, infraclavicular region and groin
the metastases were not limited to the anatomic lymph node regions.
In 5 patients (9.4%) ( 4 of them were in stage IV) lymph node
metastases were not located in the corresponding lymph node area.
32 patients without former SLNB had a time range between melanoma
excision and lymph node metastases of 31 months ( median), 21
patients with SLNB had 18 months ( p < 0.005). In 11 patients
with positive SLNB the time range was 17 months, in 10 patients
with negative SLNB 21 months ( p < 0.005); in 32 patients with
CLND the time range was 31 m< 0.005). In thinner melanomas lymph
node metastases occurred later ( p < 0.05). Conclusions: After
surgery of cutaneous melanoma, SLNB and CLND the lymphatic drainage
can show significant changes which should be considered in clinical
and ultrasound follow-up examinations. Especially for high-risk
melanoma patients follow-up examinations should be performed at
intervals of 3 months in the first years. Patients at stage IV
should be examined in all regional lymph node areas clinically and
by ultrasound. Copyright (c) 2006 S. Karger AG, Basel.