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Mary Champion, John Neis, Yelizaveta Schnayder, Jason Sokol; Sentinel Lymph Node Biopsy for Ocular Adnexal Melanomas. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2767.
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© ARVO (1962-2015); The Authors (2016-present)
Sentinel lymph node biopsy (SNLB) in ocular adnexal melanomas can identify nodal micrometastasis, providing important prognostic information and treatment guidance. We report four cases of ocular adnexal melanoma that underwent SNLB.
After institutional review board approval, medical charts of all patients with ocular adnexal melanoma who underwent SLNB at one institution between June 2011 and June 2013 were reviewed. The results of the SLNB and clinical course are the subject of this study.
Four patients age 54 to 84 years were included. The tumor sites were conjunctiva in two patients, medial canthus in one patient, and conjunctiva and orbit in one patient. One patient with conjunctival melanoma had a positive SLNB. The tumor Breslow thickness was 1.5 mm. That patient had radiation and presented less than one year later with recurrence but again no evidence of metastasis. She then underwent orbital exenteration and died less than a year later due to complications from metastatic melanoma. The other three patients had negative SNLBs. One patient had excision of the conjunctival tumor followed by topical interferon therapy for microscopic local disease with no recurrence during follow-up. The other two patients with medial canthus melanoma and conjunctival and orbital melanoma underwent wide local excision, radiation and/or chemotherapy with no recurrence or metastasis during follow-up. A mean number of 4.3 lymph nodes were biopsied. The mean Breslow thickness was 2.7 mm and could only be determined for two patients due to the tissue folding on itself or lack of depth notation on the pathology report. The mean follow-up time was 12 months. No patient experienced complications related to the SNLB.
SLNB is safe and effective for identifying nodal micrometastasis and provides prognostic information which can guide treatment. In patients with only regional disease, survival of greater than 15 years has been reported following local treatment, supporting the role of SNLB in management of these tumors. SLNB is currently indicated for conjunctival melanomas of ≥2 mm in histologic thickness and/or histologic ulceration, and for cutaneous eyelid melanomas ≥1 mm thick, those with >1 mitotic figures per high-power field, and/or those with histologic ulceration. We recommend consideration of SLNB for ocular adnexal melanomas with ulceration or those with intermediate or undeterminable thickness.
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