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Leong S.P.L.,California Pacific Medical Center and Research Institute | Leong S.P.L.,Center for Melanoma Research and Treatment | Leong S.P.L.,California Pacific Medical Center Research Institute | Witte M.,University of Arizona
Journal of Surgical Oncology | Year: 2011

Nodal status is the most important predictor in patients with solid cancer. In general, sentinel lymph node is the gateway to regional nodal metastasis and beyond. Biomarkers and gene profiles are being developed to stage and subgroup cancer patients more accurately for more effective personalized therapy. Copyright © 2011 Wiley-Liss, Inc.

Han D.,Yale University | Thomas D.C.,Yale University | Zager J.S.,Moffitt Cancer Center | Pockaj B.,Mayo Medical School | And 2 more authors.
World Journal of Clinical Oncology | Year: 2016

An estimated 73870 people will be diagnosed with melanoma in the United States in 2015, resulting in 9940 deaths. The majority of patients with cutaneous melanomas are cured with wide local excision. However, current evidence supports the use of sentinel lymph node biopsy (SLNB) given the 15%-20% of patients who harbor regional node metastasis. More importantly, the presence or absence of nodal micrometastases has been found to be the most important prognostic factor in earlystage melanoma, particularly in intermediate thickness melanoma. This review examines the development of SLNB for melanoma as a means to determine a patient' s nodal status, the efficacy of SLNB in patients with melanoma, and the biology of melanoma metastatic to sentinel lymph nodes. Prospective randomized trials have guided the development of practice guidelines for use of SLNB for melanoma and have shown the prognostic value of SLNB. Given the rapidly advancing molecular and surgical technologies, the technical aspects of diagnosis, identification, and management of regional lymph nodes in melanoma continues to evolve and to improve. Additionally, there is ongoing research examining both the role of SLNB for specific clinical scenarios and the ways to identify patients who may benefit from completion lymphadenectomy for a positive SLN. Until further data provides sufficient evidence to alter national consensusbased guidelines, SLNB with completion lymphadenectomy remains the standard of care for clinically node-negative patients found to have a positive SLN. ©2016 Baishideng Publishing Group Inc. All rights reserved.

Leong S.P.L.,California Pacific Medical Center and Research Institute | Leong S.P.L.,Center for Melanoma Research and Treatment | Leong S.P.L.,California Pacific Medical Center Research Institute | Nakakura E.K.,University of California at San Francisco | And 8 more authors.
Journal of Surgical Oncology | Year: 2011

This review on the unique patterns of metastases by common and rare types of cancer addresses regional lymphatic metastases but also demonstrates general principles by consideration of vital organ metastases. These general features of successfully treated metastases are relationships to basic biological behavior as illustrated by disease-free interval, organ-specific behavior, oligo-metastatic presentation, genetic control of the metastatic pattern, careful selection of patients for surgical resection, and the necessity of complete resection of the few patients eligible for long-term survival after resection of vital organ metastasis. Lymph node metastases, while illustrating these general features, are not related to overall survival because lymph node metastases themselves do not destroy a vital organ function, and therefore have no causal relationship to overall survival. When a cancer cell spreads to a regional lymph node, does it also simultaneously spread to the systemic site or sites? Alternatively, does the cancer spread to the regional lymph node first and then it subsequently spreads to the distant site(s) after an incubation period of growth in the lymph node? Of course, if the cancer is in its incubation stage in the lymph node, then removal of the lymph node in the majority of cases with cancer cells may be curative. The data from the sentinel lymph node era, particularly in melanoma and breast cancer, is consistent with the spectrum theory of cancer progression to the sentinel lymph node in the majority of cases prior to distant metastasis. Perhaps, different subsets of cancer may be better defined with relevant biomarkers so that mechanisms of metastasis can be more accurately defined on a molecular and genomic level. Copyright © 2011 Wiley-Liss, Inc.

Leong S.P.L.,California Pacific Medical Center and Research Institute | Leong S.P.L.,Center for Melanoma Research and Treatment | Leong S.P.L.,California Pacific Medical Center Research Institute | Gershenwald J.E.,The Surgical Center | And 8 more authors.
Journal of Surgical Oncology | Year: 2011

Nodal status in melanoma is a critically important prognostic factor for patient outcome. The survival rate drops to <10% when melanoma has spread beyond the regional lymph nodes and includes visceral involvement. In general, the process of melanoma metastasis is progressive in that dissemination of melanoma from the primary site to the regional lymph nodes occurs prior to systemic disease. The goal of this review article is to describe melanoma as a clinical model to study cancer metastasis. A future challenge is to develop a molecular taxonomy to subgroup melanoma patients at various stages of tumor progression for more accurate targeted treatment. Copyright © 2011 Wiley-Liss, Inc.

Parrett B.M.,California Pacific Medical Center | Parrett B.M.,University of California at San Francisco | Kashani-Sabet M.,Center for Melanoma Research and Treatment | Singer M.I.,California Pacific Medical Center | And 5 more authors.
Otolaryngology - Head and Neck Surgery (United States) | Year: 2012

Objective. To report the long-term significance of sentinel lymph node (SLN) biopsy on prognosis, determine falsenegative SLN occurrences, and determine risk factors for death and recurrence in a large series of patients with head and neck melanoma. Study Design. Case series with tumor registry review. Setting. Academic tertiary care medical center. Subjects and Methods. A database review was performed of all patients who underwent SLN biopsy for head and neck melanoma from 1994 to 2009. End points assessed were SLN status, recurrence, false-negative SLN results, and survival comparing SLN-positive and SLN-negative patients and different locations. Survival curves and multivariate analyses were performed. Results. SLN biopsy was performed in 365 patients. SLNs were identified in 98.6% of patients with a mean of 3.7 nodes removed from 1.6 nodal basins per patient. Median follow-up was 8 years. The SLN was positive in 40 (11%) patients. SLN-positive patients had significantly thicker melanomas, higher recurrence (P < .0001), and a significant decrease in overall survival compared with SLN-negative patients (P<.002). Scalp melanoma patients had significantly thicker melanomas and an elevated risk of SLN positivity, recurrence, and death compared with other sites. Seventeen of 365 SLN-negative patients developed regional nodal disease for a false-omission rate of 5.2% and a negative predictive value of a negative SLN to be 94.8%. Risks for false negative-SLN occurrences included thick melanomas and scalp melanomas. Conclusion. SLN biopsy is accurate in head and neck melanoma and provides significant prognostic data. Scalp melanoma patients present with thicker tumors with an increase in SLN positivity and false-negative SLN occurrences. © 2012 American Academy of Otolaryngology - Head and Neck Surgery Foundation.

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