The management of lymph nodes in nonmelanoma skin cancer patients is currently still debated. Merkel cell carcinoma (MCC), squamous cell carcinoma (SCC), pigmented epithelioid melanocytoma (PEM), and other rare skin neoplasms have a well-known risk to spread to regional lymph nodes. The use of sentinel lymph node biopsy (SLNB) could be a promising procedure to assess this risk in clinically N0 patients. Metastatic SNs have been observed in 4.5–28% SCC (according to risk factors), in 9–42% MCC, and in 14–57% PEM. We observed overall 30.8% positive SNs in 13 consecutive patients operated for high-risk nonmelanoma skin cancer between 2002 and 2011 in our institution. These high rates support recommendation to implement SLNB for nonmelanoma skin cancer especially for SCC patients. Completion lymph node dissection following positive SNs is also a matter of discussion especially in PEM. It must be remembered that a definitive survival benefit of SLNB in melanoma patients has not been proven yet. However, because of its low morbidity when compared to empiric elective lymph node dissection or radiation therapy of lymphatic basins, SLNB has allowed sparing a lot of morbidity and could therefore be used in nonmelanoma skin cancer patients, even though a significant impact on survival has not been demonstrated. 1. Introduction 20 years ago [1], sentinel lymph node biopsy (SLNB) was introduced for melanoma patients and later for numerous other tumors with lymphatic metastatic propensity. Even though surgical oncology community is divided in believers and nonbelievers regarding its application, data show that SLNB has already changed the treatments modalities in melanoma and breast cancer patients, at least with respect to TNM classification. It has allowed a better understanding of disease progression and response to treatment in patients with comparable staging groups. Nonmelanoma skin cancer with potential metastatic spreading to regional lymph nodes regroups skin lesions like high-risk squamous cell carcinoma (SCC), Merkel cell carcinoma (MCC), and pigmented epithelioid melanocytoma (PEM). Because of the low incidence of nonmelanoma skin cancer with potential metastatic spread and the lack of large clinical trials, the use of SLNB in these cases is not well established, and no guidelines are currently available. Previous studies conducted about this subject reported a high rate of positive sentinel nodes (SNs) in nonmelanoma skin cancer: 4.5–28% for SCC [2–4], 16–42% for MCC [5–7], and 14–46% for PEM [8, 9]. In this context, the role of SLNB in nonmelanoma skin
References
[1]
D. L. Morton, D. R. Wen, J. H. Wong et al., “Technical details of intraoperative lymphatic mapping for early stage melanoma,” Archives of Surgery, vol. 127, no. 4, pp. 392–399, 1992.
[2]
A. S. Ross and C. D. Schmults, “Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature,” Dermatologic Surgery, vol. 32, no. 11, pp. 1309–1321, 2006.
[3]
Y. Y. Liu, W. M. Rozen, and R. Rahdon, “Sentinel lymph node biopsy for squamous cell carcinoma of the extremities: case report and review of the literature,” Anticancer Research, vol. 31, no. 4, pp. 1443–1446, 2011.
[4]
C. Renzi, A. Caggiati, T. J. Mannooranparampil et al., “Sentinel lymph node biopsy for high risk cutaneous squamous cell carcinoma: case series and review of the literature,” European Journal of Surgical Oncology, vol. 33, no. 3, pp. 364–369, 2007.
[5]
P. J. Allen, W. B. Bowne, D. P. Jaques, M. F. Brennan, K. Busam, and D. G. Coit, “Merkel cell carcinoma: prognosis and treatment of patients from a single institution,” Journal of Clinical Oncology, vol. 23, no. 10, pp. 2300–2309, 2005.
[6]
S. E. Ames, D. N. Krag, and M. S. Brady, “Radiolocalization of the sentinel lymph node in Merkel cell carcinoma: a clinical analysis of seven cases,” Journal of Surgical Oncology, vol. 67, no. 4, pp. 251–254, 1998.
[7]
S. G. Gupta, L. C. Wang, P. F. Pe？as, M. Gellenthin, S. J. Lee, and P. Nghiem, “Sentinel lymph node biopsy for evaluation and treatment of patients with Merkel cell carcinoma: the Dana-Farber experience and meta-analysis of the literature,” Archives of Dermatology, vol. 142, no. 6, pp. 685–690, 2006.
[8]
A. Zembowicz, J. A. Carney, and M. C. Mihm, “Pigmented Epithelioid Melanocytoma: a low-grade melanocytic tumor with metastatic potential indistinguishable from animal-type melanoma and epithelioid blue nevus,” American Journal of Surgical Pathology, vol. 28, no. 1, pp. 31–40, 2004.
[9]
C. M. Magro, A. N. Crowson, M. C. Mihm, K. Gupta, M. J. Walker, and G. Solomon, “The dermal-based borderline melanocytic tumor: a categorical approach,” Journal of the American Academy of Dermatology, vol. 62, no. 3, pp. 469–479, 2010.
[10]
M. Matter, M. N. Lalonde, M. Allaoua et al., “The role of interval nodes in sentinel lymph node mapping and dissection for melanoma patients,” Journal of Nuclear Medicine, vol. 48, no. 10, pp. 1607–1613, 2007.
[11]
S. Maza, U. Trefzer, M. Hofmann et al., “Impact of sentinel lymph node biopsy in patients with Merkel cell carcinoma: results of a prospective study and review of the literature,” European Journal of Nuclear Medicine and Molecular Imaging, vol. 33, no. 4, pp. 433–440, 2006.
[12]
J. Ortin-Perez, M. C. van Rijk, R. A. Valdes-Olmos et al., “Lymphatic mapping and sentinel node biopsy in Merkel's cell carcinoma,” European Journal of Surgical Oncology, vol. 33, no. 1, pp. 119–122, 2007.
[13]
R. E. Warner, M. J. Quinn, G. Hruby, R. A. Scolyer, R. F. Uren, and J. F. Thompson, “Management of Merkel cell carcinoma: the roles of lymphoscintigraphy, sentinel lymph node biopsy and adjuvant radiotherapy,” Annals of Surgical Oncology, vol. 15, no. 9, pp. 2509–2518, 2008.
[14]
Y. Shnayder, D. T. Weed, D. J. Arnold et al., “Management of the neck in Merkel cell carcinoma of the head and neck: University of Miami experience,” Head and Neck, vol. 30, no. 12, pp. 1559–1565, 2008.
[15]
E. Bajetta, L. Celio, M. Platania et al., “Single-institution series of early-stage merkel cell carcinoma: long-term outcomes in 95 patients managed with surgery alone,” Annals of Surgical Oncology, vol. 16, no. 11, pp. 2985–2993, 2009.
[16]
R. C. Fields, K. J. Busam, J. F. Chou et al., “Recurrence and survival in patients undergoing sentinel lymph node biopsy for merkel cell carcinoma: analysis of 153 patients from a single institution,” Annals of Surgical Oncology, vol. 18, no. 9, pp. 2529–2537, 2011.
[17]
J. Howle and M. Veness, “Sentinel lymph node biopsy in patients with Merkel cell carcinoma: an emerging role and the Westmead hospital experience,” The Australasian Journal of Dermatology, vol. 53, no. 1, pp. 26–31, 2012.
[18]
R. Cecchi, L. Buralli, and C. De Gaudioc, “Sentinel lymphonodectomy in non-melanoma skin cancers,” Chirurgia Italiana, vol. 58, no. 3, pp. 347–351, 2006.
[19]
J. D. Wagner, D. Z. Evdokimow, E. Weisberger et al., “Sentinel node biopsy for high-risk nonmelanoma cutaneous malignancy,” Archives of Dermatology, vol. 140, no. 1, pp. 75–79, 2004.
[20]
F. J. Civantos, F. L. Moffat, and W. J. Goodwin, “Lymphatic mapping and sentinel lymphadenectomy for 106 head and neck lesions: contrasts between oral cavity and cutaneous malignancy,” Laryngoscope, vol. 116, no. 3, pp. 1–15, 2006.
[21]
K. U. Sian, J. D. Wagner, R. Sood, H. M. Park, R. Havlik, and J. J. Coleman, “Lymphoscintigraphy with sentinel lymph node biopsy in cutaneous merkel cell carcinoma,” Annals of Plastic Surgery, vol. 42, no. 6, pp. 679–682, 1999.
[22]
F. C. Cobey, L. H. Engrav, M. B. Klein, C. N. Isom, and D. R. Byrd, “Brief report: sentinel lymph node dissection and burn scar carcinoma. Sentinel node and burn scar carcinoma,” Burns, vol. 34, no. 2, pp. 271–274, 2008.
[23]
N. Hatta, R. Morita, M. Yamada, K. Takehara, K. Ichiyanagi, and K. Yokoyama, “Implications of popliteal lymph node detected by sentinel lymph node biopsy,” Dermatologic Surgery, vol. 31, no. 3, pp. 327–330, 2005.
[24]
A. Lucci, L. M. McCall, P. D. Beitsch et al., “Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group trial Z0011,” Journal of Clinical Oncology, vol. 25, no. 24, pp. 3657–3663, 2007.
[25]
W. R. Wrightson, S. L. Wong, M. J. Edwards et al., “Complications associated with sentinel lymph node biopsy for melanoma,” Annals of Surgical Oncology, vol. 10, no. 6, pp. 676–680, 2003.
[26]
Y. Masannat, H. Shenoy, V. Speirs, A. Hanby, and K. Horgan, “Properties and characteristics of the dyes injected to assist axillary sentinel node localization in breast surgery,” European Journal of Surgical Oncology, vol. 32, no. 4, pp. 381–384, 2006.
[27]
M. J. Reschly, J. L. Messina, L. L. Zaulyanov, W. Cruse, and N. A. Fenske, “Utility of sentinel lymphadenectomy in the management of patients with high-risk cutaneous squamous cell carcinoma,” Dermatologic Surgery, vol. 29, no. 2, pp. 135–140, 2003.
[28]
K. D. Brantsch, C. Meisner, B. Sch？nfisch et al., “Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study,” The Lancet Oncology, vol. 9, no. 8, pp. 713–720, 2008.
[29]
M. J. Veness, “Defining patients with high-risk cutaneous squamous cell carcinoma,” The Australasian Journal of Dermatology, vol. 47, no. 1, pp. 28–33, 2006.
[30]
J. T. Mullen, L. Feng, Y. Xing et al., “Invasive squamous cell carcinoma of the skin: defining a high-risk group,” Annals of Surgical Oncology, vol. 13, no. 7, pp. 902–909, 2006.
[31]
B. S. Cherpelis, C. Marcusen, and P. G. Lang, “Prognostic factors for metastasis in squamous cell carcinoma of the skin,” Dermatologic Surgery, vol. 28, no. 3, pp. 268–273, 2002.
[32]
F. O. Zwald and M. Brown, “Skin cancer in solid organ transplant recipients: advances in therapy and management: part I. Epidemiology of skin cancer in solid organ transplant recipients,” Journal of the American Academy of Dermatology, vol. 65, no. 2, pp. 263–279, 2011.
[33]
J. J. Bonerandi, C. Beauvillain, L. Caquant et al., “Guidelines for the diagnosis and treatment of cutaneous squamous cell carcinoma and precursor lesions,” Journal of the European Academy of Dermatology and Venereology, vol. 25, supplement 5, pp. 1s–51s, 2011.
[34]
H. Demir, T. Isken, E. Kus et al., “Sentinel lymph node biopsy with a gamma probe in patients with high-risk cutaneous squamous cell carcinoma: follow-up results of sentinel lymph node-negative patients,” Nuclear Medicine Communications, vol. 32, no. 12, pp. 1216–1222, 2011.
[35]
S. Kwon, Z. M. Dong, and P. C. Wu, “Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: clinical experience and review of literature,” World Journal of Surgical Oncology, vol. 9, p. 80, 2011.
[36]
A. Jambusaria-Pahlajani, S. D. Hess, K. A. Katz, D. Berg, and C. D. Schmults, “Uncertainty in the perioperative management of high-risk cutaneous squamous cell carcinoma among Mohs surgeons,” Archives of Dermatology, vol. 146, no. 11, pp. 1225–1231, 2010.
[37]
A. L. Eastman, W. A. Erdman, G. M. Lindberg, J. L. Hunt, G. F. Purdue, and J. B. Fleming, “Sentinel lymph node biopsy identifies occult nodal metastases in patients with Marjolin's ulcer,” Journal of Burn Care and Rehabilitation, vol. 25, no. 3, pp. 241–245, 2004.
[38]
R. Cecchi, L. Buralli, and C. De Gaudio, “Lymphatic mapping and sentinel lymphonodectomy in recurrent cutaneous squamous cell carcinomas,” European Journal of Dermatology, vol. 15, no. 6, pp. 478–479, 2005.
[39]
M. Yamada, N. Hatta, K. Sogo, K. Komura, Y. Hamaguchi, and K. Takehara, “Management of squamous cell carcinoma in a patient with recessive-type epidermolysis bullosa dystrophica,” Dermatologic Surgery, vol. 30, no. 11, pp. 1424–1429, 2004.
[40]
K. B. Calder and B. R. Smoller, “New insights into merkel cell carcinoma,” Advances in Anatomic Pathology, vol. 17, no. 3, pp. 155–161, 2010.
[41]
H. T. Eich, D. Eich, S. Staar et al., “Role of postoperative radiotherapy in the management of Merkel cell carcinoma,” American Journal of Clinical Oncology, vol. 25, no. 1, pp. 50–56, 2002.
[42]
P. Mojica, D. Smith, and J. D. I. Ellenhorn, “Adjuvant radiation therapy is associated with improved survival in merkel cell carcinoma of the skin,” Journal of Clinical Oncology, vol. 25, no. 9, pp. 1043–1047, 2007.
[43]
W. Goessling, P. H. McKee, and R. J. Mayer, “Merkel cell carcinoma,” Journal of Clinical Oncology, vol. 20, no. 2, pp. 588–598, 2002.
[44]
J. B. Stokes, K. S. Graw, L. T. Dengel et al., “Patients with Merkel cell carcinoma tumors ≤ 1.0 cm in diameter are unlikely to harbor regional lymph node metastasis,” Journal of Clinical Oncology, vol. 27, no. 23, pp. 3772–3777, 2009.
[45]
J. L. Schwartz, K. A. Griffith, L. Lowe et al., “Features predicting sentinel lymph node positivity in merkel cell carcinoma,” Journal of Clinical Oncology, vol. 29, no. 8, pp. 1036–1041, 2011.
[46]
L. D. Su, L. Lowe, C. R. Bradford, A. I. Yahanda, T. M. Johnson, and V. K. Sondak, “Immunostaining for cytokeratin 20 improves detection of micrometastatic Merkel cell carcinoma in sentinel lymph nodes,” Journal of the American Academy of Dermatology, vol. 46, no. 5, pp. 661–666, 2002.
[47]
P. J. Allen, K. Busam, A. D. K. Hill, A. Stojadinovic, and D. G. Coit, “Immunohistochemical analysis of sentinel lymph nodes from patients with Merkel cell carcinoma,” Cancer, vol. 92, no. 6, pp. 1650–1655, 2001.
[48]
T. S. Wang, P. J. Byrne, L. K. Jacobs, and J. M. Taube, “Merkel cell carcinoma: update and review,” Seminars in Cutaneous Medicine and Surgery, vol. 30, no. 1, pp. 48–56, 2011.
[49]
J. H. Ruan and M. Reeves, “A Merkel cell carcinoma treatment algorithm,” Archives of Surgery, vol. 144, no. 6, pp. 582–585, 2009.
[50]
J. F. Buell, J. Trofe, M. J. Hanaway et al., “Immunosuppression and merkel cell cancer,” Transplantation Proceedings, vol. 34, no. 5, pp. 1780–1781, 2002.
[51]
B. D. Lemos, B. E. Storer, J. G. Iyer et al., “Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system,” Journal of the American Academy of Dermatology, vol. 63, no. 5, pp. 751–761, 2010.
[52]
R. Murali, R. N. Sharma, J. F. Thompson et al., “Sentinel lymph node biopsy in histologically ambiguous melanocytic tumors with spitzoid features (so-called atypical spitzoid tumors),” Annals of Surgical Oncology, vol. 15, no. 1, pp. 302–309, 2008.
[53]
R. V. Mandal, R. Murali, K. F. Lundquist et al., “Pigmented epithelioid melanocytoma: favorable outcome after 5-year follow-up,” American Journal of Surgical Pathology, vol. 33, no. 12, pp. 1778–1782, 2009.
[54]
K. L. Hollowell, S. C. Agle, E. E. Zervos, and T. L. Fitzgerald, “Cutaneous apocrine adenocarcinoma: defining epidemiology, outcomes, and optimal therapy for a rare neoplasm,” Journal of Surgical Oncology, vol. 105, no. 4, pp. 415–419, 2012.
[55]
H. C. Hsu, C. Y. Ho, C. H. Chen, C. H. Yang, H. S. Hong, and Y. H. Chuang, “Aggressive digital papillary adenocarcinoma: a review,” Clinical and Experimental Dermatology, vol. 35, no. 2, pp. 113–119, 2010.
[56]
M. Beyeler, W. Kempf, J. Hafner, G. Burg, and R. Dummer, “The spectrum of mesenchymal skin neoplasms reflected by the new WHO classification,” Onkologie, vol. 27, no. 4, pp. 401–406, 2004.
[57]
E. S. T. Tan, M. B. Y. Tang, and S. H. Tan, “Retrospective 5-year review of 131 patients with mycosis fungoides and Sézary syndrome seen at the National Skin Centre, Singapore,” The Australasian Journal of Dermatology, vol. 47, no. 4, pp. 248–252, 2006.
[58]
C. H. Wang, H. C. Nien, M. F. Hou, G. S. Chen, and S. T. Cheng, “Sentinel lymphadenectomy for circumscribed cutaneous T-cell lymphoma,” Dermatologic Surgery, vol. 30, no. 6, pp. 952–956, 2004.
