Ultrasound Examination of the Lymphatic Drainage Area and Regional Lymph Nodes in Melanoma Patients with In-Transit Meta
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ORIGINAL ARTICLE – MELANOMA
Ultrasound Examination of the Lymphatic Drainage Area and Regional Lymph Nodes in Melanoma Patients with In-Transit Metastases Amanda Nijhuis, MD, PhD1,2, David Chung, MD, PhD3,4, Kevin London, MD, PhD4,5, Roger Uren, MD3,4, John Thompson, MD1,3,6, and Omgo Nieweg, MD, PhD1,3,6 1
Melanoma Institute Australia, Sydney, NSW, Australia; 2Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; 3Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; 4Alfred Nuclear Medicine and Ultrasound, The University of Sydney, Sydney, NSW, Australia; 5Department of Nuclear Medicine, Westmead Hospital, Westmead, NSW, Australia; 6Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
ABSTRACT Background. In-transit metastases (ITMs) are cutaneous or subcutaneous regional metastases that may occur in patients with melanoma. ITMs are often multiple and new lesions tend to appear over time. Ultrasonography can detect impalpable subcutaneous tumors. Objective. The aim of this study was to assess the value of ultrasound examination in detecting additional, non-palpable ITMs and to determine their relevance. Methods. Melanoma patients with ITMs who underwent regional ultrasound examination of the skin and subcutaneous tissue between the wide excision scar of the primary melanoma and the regional lymph node field were identified. In most, ultrasound assessment also included the regional lymph node field. Relevant data were collected and analyzed. Results. Twenty-eight patients presenting with a total of 40 ITMs were included. Ultrasound examination identified additional ITMs in 15 patients (54%). No nodal recurrences were detected. Most additional lesions were found closer to the regional lymph nodes than the original ITMs. Management was influenced by the ultrasound findings in nine patients (32%), five of whom had more extensive surgery,
Society of Surgical Oncology 2020 First Received: 1 April 2020 Accepted: 24 August 2020 A. Nijhuis, MD, PhD e-mail: [email protected]
three received systemic drug therapy instead of surgery, and in one patient surgery was delayed and follow-up intensified. In one patient, only subcutaneous fat was found in the excised specimen and the ultrasound was classified as false-positive. Conclusion. In melanoma patients with ITMs, ultrasonography of the lymphatic drainage area provided valuable information, as additional ITMs were identified in more than half of these patients and management was influenced in one-third.
In-transit metastases (ITMs) occur in about 4% of patients with cutaneous melanoma.1,2 These lesions develop in cutaneous or subcutaneous lymphatics between the primary tumor site and the regional lymph node field (Fig. 1). Multiple ITMs often appear simultaneously and additional lesions tend to become apparent over time.3 The prognostic implications of ITMs are serious, as some 43% of patients will also develop potentially lethal distant metastases.1 Patients pr
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