Sentinel Node Biopsy for Conjunctival Melanoma; Single Centre Experience and Review of Current Literature

Overview

Journal Cancer Control

Specialty Oncology

Date 2021 Oct 11

PMID 34633246

Authors

Barbara Peric

Spela Leiler

Gregor Hawlina

Boris Jancar

Marko Snoj

Andraz Perhavec

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate the role of sentinel lymph node (SLN) biopsy in patients with conjuctival melanoma (CjM).

Study Design: Retrospective observational cohort study and literature review.

Subjects: Slovenian patients with CjM are included in the study.

Methods: Prospectively collected data of CjM patients treated from June 2005 to December 2016 were retrospectively analyzed.

Main Outcome Measures: The numbers of SLN biopsy procedures, positive and false positive SLN, and local and regional relapses have been described together with overall survival.

Results: From June 2005 until December 2016, 24 patients with CjM were treated. The median follow-up time was 65.3 months. The mean Breslow thickness was 1.5 mm (sd = 1.8 mm), and ulceration was present in 29% of cases. Altogether, 14/24 (58%) SLN biopsy procedures were performed. SLN was positive in 2/14 (14%) cases. The estimated 5-year overall survival (OS) of the group was 72.5%, with a median survival of 151 months (95% CI 77-224). From January 2013 to January 2020, five (5/140, 3%) authors reported results comparable to our study.

Conclusion: Our results confirm that CjM is a rare disease with approximately 14% of positive SLN. At the moment, there are no firm conclusions regarding who would benefit most from SLN biopsy or whether or not CLND should be offered. Data from literature emphasize the need for consistent and uniform staging and future multicentric studies.

References

Wong J, Nanji A, Galor A, Karp C . Management of conjunctival malignant melanoma: a review and update. Expert Rev Ophthalmol. 2015; 9(3):185-204. PMC: 4285629. DOI: 10.1586/17469899.2014.921119. View

Esmaeli B, Rubin M, Xu S, Goepfert R, Curry J, Prieto V . Greater Tumor Thickness, Ulceration, and Positive Sentinel Lymph Node Are Associated With Worse Prognosis in Patients With Conjunctival Melanoma: Implications for Future AJCC Classifications. Am J Surg Pathol. 2019; 43(12):1701-1710. DOI: 10.1097/PAS.0000000000001344. View

Hu D, Yu G, McCormick S, Finger P . Population-based incidence of conjunctival melanoma in various races and ethnic groups and comparison with other melanomas. Am J Ophthalmol. 2008; 145(3):418-423. DOI: 10.1016/j.ajo.2007.10.022. View

Missotten G, Keijser S, de Keizer R, de Wolff-Rouendaal D . Conjunctival melanoma in the Netherlands: a nationwide study. Invest Ophthalmol Vis Sci. 2004; 46(1):75-82. DOI: 10.1167/iovs.04-0344. View

Esmaeli B . Inclusion of Histologic Ulceration and Tumor Thickness in Future American Joint Committee on Cancer T Category Definitions for Conjunctival Melanoma. JAMA Ophthalmol. 2019; 137(8):912-913. DOI: 10.1001/jamaophthalmol.2019.1656. View

Faries M, Thompson J, Cochran A, Andtbacka R, Mozzillo N, Zager J . Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017; 376(23):2211-2222. PMC: 5548388. DOI: 10.1056/NEJMoa1613210. View

Pfeiffer M, Savar A, Esmaeli B . Sentinel lymph node biopsy for eyelid and conjunctival tumors: what have we learned in the past decade?. Ophthalmic Plast Reconstr Surg. 2013; 29(1):57-62. DOI: 10.1097/IOP.0b013e31827472c5. View

Leiter U, Stadler R, Mauch C, Hohenberger W, Brockmeyer N, Berking C . 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(6):757-767. DOI: 10.1016/S1470-2045(16)00141-8. View

Vora G, Demirci H, Marr B, Mruthyunjaya P . Advances in the management of conjunctival melanoma. Surv Ophthalmol. 2016; 62(1):26-42. PMC: 5353981. DOI: 10.1016/j.survophthal.2016.06.001. View

10.

Cohen V, Tsimpida M, Hungerford J, Jan H, Cerio R, Moir G . Prospective study of sentinel lymph node biopsy for conjunctival melanoma. Br J Ophthalmol. 2013; 97(12):1525-9. PMC: 3841742. DOI: 10.1136/bjophthalmol-2013-303671. View

11.

van der Ploeg A, van Akkooi A, Haydu L, Scolyer R, Murali R, Verhoef C . The prognostic significance of sentinel node tumour burden in melanoma patients: an international, multicenter study of 1539 sentinel node-positive melanoma patients. Eur J Cancer. 2013; 50(1):111-20. DOI: 10.1016/j.ejca.2013.08.023. View

12.

Shields C, Markowitz J, Belinsky I, Schwartzstein H, George N, Lally S . Conjunctival melanoma: outcomes based on tumor origin in 382 consecutive cases. Ophthalmology. 2010; 118(2):389-95.e1-2. DOI: 10.1016/j.ophtha.2010.06.021. View

13.

Mendoza P, Grossniklaus H . Sentinel lymph node biopsy for eyelid and conjunctival tumors: what is the evidence?. Int Ophthalmol Clin. 2014; 55(1):123-36. PMC: 4548266. DOI: 10.1097/IIO.0000000000000051. View

14.

Brouwer N, Marinkovic M, van Duinen S, Bleeker J, Jager M, Luyten G . Treatment of conjunctival melanoma in a Dutch referral centre. Br J Ophthalmol. 2017; 102(9):1277-1282. DOI: 10.1136/bjophthalmol-2017-311082. View

15.

Madu M, Wouters M, van Akkooi A . Sentinel node biopsy in melanoma: Current controversies addressed. Eur J Surg Oncol. 2016; 43(3):517-533. DOI: 10.1016/j.ejso.2016.08.007. View

16.

Sekoranja D, Vergot K, Hawlina G, Pizem J . Combined deep penetrating nevi of the conjunctiva are relatively common lesions characterised by BRAFV600E mutation and activation of the beta catenin pathway: a clinicopathological analysis of 34 lesions. Br J Ophthalmol. 2019; 104(7):1016-1021. DOI: 10.1136/bjophthalmol-2019-314807. View

17.

Mor J, Rokohl A, Koch K, Heindl L . Sentinel lymph node biopsy in the management of conjunctival melanoma: current insights. Clin Ophthalmol. 2019; 13:1297-1302. PMC: 6667347. DOI: 10.2147/OPTH.S187364. View