This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on Web of Science (10)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Dermatologic Disorders  • Neoplasms  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

Update of Current Concepts

Timothy M. Johnson, MD; Carol R. Bradford, MD; Stephen B. Gruber, MD, PhD; Vernon K. Sondak, MD; Jennifer L. Schwartz, MD

Arch Dermatol. 2004;140:107-113.

Objectives  To clarify and update workup and follow-up strategies based on fundamental principles and current data, and to discuss new and current concepts regarding sentinel lymph node biopsy (SLNB), particularly in relation to the staging workup.

Data Sources  Studies conducted from 1995 to 2003 were identified by PubMed search. Additional searches included workup for reference lists of retrieved articles when applicable, and PubMed-related articles.

Study Selection  Contemporary studies with good design, conclusions based on sound methods, and results pertaining to staging workup, SLNB, and follow-up tests were critically reviewed.

Data Extraction  Data and conclusions based on the above studies were incorporated into a review.

Data Synthesis  Routine tests have marginal to no efficacy and are not cost-efficient for detecting occult disease in asymptomatic patients with localized melanoma. The only staging test that has relatively high sensitivity and specificity and provides tissue diagnosis is SLNB; moreover, SLNB has revolutionized our understanding of lymphatic pathways. The concepts of interval nodes and unexpected lymphatic drainage pathways have been addressed by several recent reports. There are no data that demonstrate any significant difference in overall survival for detection of asymptomatic vs symptomatic stage IV melanoma.

Conclusions  An initial workup is useful for staging and prognosis to identify occult disease, with potential outcome benefit if treated early; and, by detecting distant occult disease (stage IV), to obviate the need for an extensive surgical procedure and thereby avoid associated increased morbidity. The foundation for the workup and follow-up remains thorough history taking and a physical examination, combined with a low index of suspicion for symptom-directed tests.

From the Departments of Dermatology (Drs Johnson and Schwartz), Otolaryngology (Drs Johnson and Bradford), Internal Medicine and Epidemiology (Dr Gruber), and Surgery (Drs Johnson and Sondak), University of Michigan Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor. The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLES

Early Detection of Asymptomatic Pulmonary Melanoma Metastases by Routine Chest Radiographs Is Not Associated With Improved Survival
Hensin Tsao, Myra Feldman, Julie E. Fullerton, Arthur J. Sober, Daniel Rosenthal, and William Goggins
Arch Dermatol. 2004;140(1):67-70.
ABSTRACT | FULL TEXT  

Sentinel Node Biopsy for High-Risk Nonmelanoma Cutaneous Malignancy
Jeffrey D. Wagner, David Z. Evdokimow, Edward Weisberger, David Moore, Tsu-Yi Chuang, Stacie Wenck, and John J. Coleman, III
Arch Dermatol. 2004;140(1):75-79.
ABSTRACT | FULL TEXT  

Primary Dermal Melanoma: A Distinct Subtype of Melanoma
Susan M. Swetter, Phillip M. Ecker, Denise L. Johnson, and Jeff D. Harvell
Arch Dermatol. 2004;140(1):99-103.
ABSTRACT | FULL TEXT