Previous wide local excision of primary melanoma is not a contraindication for sentinel lymph node biopsy of the trunk and extremity

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Abstract
Background and Objectives The role of sentinel lymph node biopsy (SLNB) in patients with a previous wide local excision (WLE) was examined with case-control methodology. Methods A total of 168 consecutive cases of SLNB were performed in patients with truncal and extremity melanoma with tumor thickness of ≥1 mm between October 1997 and June 2000 and were followed prospectively. For comparison, 65 of the103 SLNB patients referred to us after their WLE (cases) were matched by tumor thickness to 65 patients who had SLNB with concurrent WLE (controls). Radiocolloid (technetium-99m sulfur colloid) was used in all cases; in addition, vital blue dye (patent blue) was used in the control group. The two groups were followed for a median of 15.4 months. Results SLNs were identified in all patients with an average of 2.1 (cases) and 2.0 (controls) SLNs excised per patient (P = 0.77). Twenty one (32.3%) of those having SLNB after previous WLE (cases) and 23 (35.4%) of those with concurrent WLE and SLNB (controls) were found to have metastatic disease in the SLN. The only false-negative in this group was detected in clinical follow-up in a patient whose truncal WLE was previously closed with a rotation flap (case). There was no significant difference in relapse-free survival (P = 0.209) and overall survival (P = 0.692) between groups. Conclusions SLNB is feasible in patients with previous WLE for extremity and truncal melanoma. Similar rates of sentinel positivity are found when compared with those in whom their WLE was done concurrently. J. Surg. Oncol. 2003;82:143–146.