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Ultrasound Examination of the Lymphatic Drainage Area and Regional Lymph Nodes in Melanoma Patients with In-Transit Metastases

  • Melanoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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, 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.

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References

  1. Read RL, Haydu LE, Saw RPM, Quinn MJ, Shannon K, Spillane AJ, et al. In-transit melanoma metastases: incidence, prognosis, and the role of lymphadenectomy. Ann Surg Oncol 2015;22:475–81.

    Article  Google Scholar 

  2. Hoekstra HJ. The European approach to in-transit melanoma lesions. Int J Hyperth 2008;24:227–37.

    Article  CAS  Google Scholar 

  3. Corvino A, Corvino F, Catalano O, Sandomenico F, Petrillo A. The Tail and the String Sign: New Sonographic Features of Subcutaneous Melanoma Metastasis. Ultrasound Med Biol 2017;43:370–4.

    Article  Google Scholar 

  4. Gershenwald JE, Scolyer RA, Hess KR, Sondak VK, Long GV, Ross MI, et al. Melanoma staging: evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 2017;76:472–92.

    Article  Google Scholar 

  5. Thompson JF. Local and regional therapies for melanoma: many arrows in the quiver. J Surg Oncol. 2014;109:295.

    Article  Google Scholar 

  6. Testori A, Ribero S, Bataille V. Diagnosis and treatment of in-transit melanoma metastases. Eur J Surg Oncol 2017;43:544–60.

    Article  CAS  Google Scholar 

  7. Uren RF, Sanki A, Thompson JF. The utility of ultrasound in patients with melanoma. Expert Rev Anticancer Ther 2007;7:1633–42.

    Article  Google Scholar 

  8. Nazarian LN, Alexander AA, Kurtz AB, Capuzzi DM, Rawool NM, Gilbert KR, et al. Superficial melanoma metastases: appeareances on gray-scale and color doppler sonography. Am J Roentgenol 1998;170:459–63.

    Article  CAS  Google Scholar 

  9. Alexander AA, Nazarian LN, Capuzzi DM, Rawool NM, Kurtz AB, Mastrangelo MJ. Color Doppler sonographic detection of tumor flow in superficial melanoma metastases: histologic correlation. J Ultrasound Med 1998;17:123–6.

    Article  CAS  Google Scholar 

  10. Sanki A, Uren RF, Moncrieff M, Tran KL, Scolyer RA, Lin HY, et al. Targeted high-resolution ultrasound is not an effective substitute for sentinel lymph node biopsy in patients with primary cutaneous melanoma. J Clin Oncol 2009;27:5614–9.

    Article  Google Scholar 

  11. Nazarian LN, Alexander A, Rawool NM, Kurtz AB, Maguire HC, Mastrangelo MJ. Malignant melanoma: impact of superficial US on Management. Radiology 1996;199:273–7.

    Article  CAS  Google Scholar 

  12. Solivetti FM, Di Luca Sidozzi A, Pirozzi G, Coscarella G, Brigida R, Eibenshutz L. Sonographic evaluation of clinically occult in-transit and satellite metastases from cutaneous malignant melanoma. Radiol Medica 2006;111:702–8.

    Article  CAS  Google Scholar 

  13. Bafounta ML, Beauchet A, Chagnon S, Saiag P. Ultrasonography or palpation for detection of melanoma nodal invasion: a meta-analysis. Lancet Oncol 2004;5:673–80.

    Article  Google Scholar 

  14. Binder M, Kittler H, Steiner A, Dorffner R, Wolff K, Pehamberger H. Lymph node sonography versus palpation for detecting recurrent disease in patients with malignant melanoma. Eur J Cancer 1997;33:1805–8.

    Article  CAS  Google Scholar 

  15. Blum A, Schlagenhauff B, Stroebel W, Breuninger H, Rassner G, Garbe C. Ultrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow-up of patients with cutaneous melanoma: results of a prospective study of 1288 patients. Cancer 2000;88:2534–9.

    Article  CAS  Google Scholar 

  16. Garbe C, Paul A, Kohler-Späth H, Ellwanger U, Stroebel W, Schwarz M, et al. Prospective evaluation of a follow-up schedule in cutaneous melanoma patients: recommendations for an effective follow-up strategy. J Clin Oncol 2003;21:520–9.

    Article  Google Scholar 

  17. Prayer L, Winkelbauer H, Gritzmann N, Winkelbauer F, Helmer M, Pehamberger H. Sonography versus palpation in the detection of regional lymph-node metastases in patients with malignant melanoma. Eur J Cancer Clin Oncol 1990;26:827–30.

    Article  CAS  Google Scholar 

  18. Rossi CR, Seno A, Vecchiato A, Foletto M, Tregnaghi A, De Candia A, et al. The impact of ultrasound scanning in the staging and follow-up of patients with clinical stage I cutaneous melanoma. Eur J Cancer. 1997;33:200–3.

    Article  CAS  Google Scholar 

  19. Schmid-Wendtner MH, Paerschke G, Baumert J, Plewig G, Volkenandt M. Value of ultrasonography compared with physical examination for the detection of locoregional metastases in patients with cutaneous melanoma. Melanoma Res 2003;13:183–8.

    Article  Google Scholar 

  20. Voit C, Mayer T, Kron M, Schoengen A, Sterry W, Weber L, et al. Efficacy of ultrasound B-scan compared with physical examination in follow-up of melanoma patients. Cancer 2001;91:2409–16.

    Article  CAS  Google Scholar 

  21. Thompson JF, Haydu LE, Uren RF, Andtbacka RH, Zager JS, Beitsch PD, et al. Preoperative ultrasound assessment of regional lymph nodes in melanoma patients does not provide reliable nodal staging. Ann Surg. Epub 7 Jun 2019. https://doi.org/10.1097/sla.0000000000003405.

  22. Van Rijk MC, Teertstra HJ, Peterse JL, Nieweg OE, Valdés Olmos RA, Hoefnagel CA, et al. Ultrasonography and fine-needle aspiration cytology in the preoperative evaluation of melanoma patients eligible for sentinel node biopsy. Ann Surg Oncol 2006;13:1511–6.

    Article  Google Scholar 

  23. Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol 2016;17:757–67.

    Article  Google Scholar 

  24. [24] Faries MB, Thompson JF, Cochran AJ, Andtbacka RH, Mozzillo N, Zager JS, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med 2017;376:2211–22.

    Article  Google Scholar 

  25. [25] Coit D. The Enigma of regional lymph nodes in melanoma. N Engl J Med 2017;376:2280–1.

    Article  Google Scholar 

  26. Holtkamp LHJ, Chakera A, Fung S, Stretch JR, Saw R, Lee K, et al. Staging 18 F-FDG PET/CT influences the melanoma treatment plan in patients with (micro)satellites or in-transit metastases. Ann Surg Oncol 2017;24:S131.

    Article  Google Scholar 

  27. Solivetti FM, Desiderio F, Guerrisi A, Bonadies A, Maini CL, Di Filippo S, et al. HF ultrasound vs PET-CT and telethermography in the diagnosis of In-transit metastases from melanoma: a prospective study and review of the literature. J Exp Clin Cancer Res 2014;33:96.

    Article  Google Scholar 

  28. Nijhuis AAG, De AO Santos ID, Holtkamp LHJ, Uren RF, Thompson JF, Nieweg OE. Sentinel node biopsy in melanoma patients with a local recurrence or in-transit metastasis. Ann Surg Oncol 2019;26:S44.

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Authors and Affiliations

  1. Melanoma Institute Australia, Sydney, NSW, Australia

    Amanda Nijhuis MD, PhD, John Thompson MD & Omgo Nieweg MD, PhD

  2. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    Amanda Nijhuis MD, PhD

  3. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    David Chung MD, PhD, Roger Uren MD, John Thompson MD & Omgo Nieweg MD, PhD

  4. Alfred Nuclear Medicine and Ultrasound, The University of Sydney, Sydney, NSW, Australia

    David Chung MD, PhD, Kevin London MD, PhD & Roger Uren MD

  5. Department of Nuclear Medicine, Westmead Hospital, Westmead, NSW, Australia

    Kevin London MD, PhD

  6. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    John Thompson MD & Omgo Nieweg MD, PhD

Authors
  1. Amanda Nijhuis MD, PhD
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  2. David Chung MD, PhD
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  3. Kevin London MD, PhD
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  4. Roger Uren MD
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  5. John Thompson MD
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  6. Omgo Nieweg MD, PhD
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Corresponding author

Correspondence to Amanda Nijhuis MD, PhD.

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Disclosures

Professor John Thompson has received honoraria for advisory board participation from Merck Sharpe Dohme Australia and Bristol Myers Squibb Australia, and has also received honoraria and travel expenses from GlaxoSmithKline and Provectus Inc. Amanda Nijhuis, David Chung, Kevin London, Ruger Uren, and Omgo Nieweg have no disclosures to declare.

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Nijhuis, A., Chung, D., London, K. et al. Ultrasound Examination of the Lymphatic Drainage Area and Regional Lymph Nodes in Melanoma Patients with In-Transit Metastases. Ann Surg Oncol 28, 1625–1631 (2021). https://doi.org/10.1245/s10434-020-09240-9

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  • DOI: https://doi.org/10.1245/s10434-020-09240-9

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