Micrometastasis to in-transit lymph nodes from extremity and truncal malignant melanoma

Ann Surg Oncol. 2001 Jun;8(5):444-8. doi: 10.1007/s10434-001-0444-3.


Background: The sentinel lymph node (SLN) is the first lymph node in the regional nodal basin to receive metastatic cells. In-transit nodes are found between the primary melanoma site and regional nodal basins. To date, this is one of the first reports on micrometastasis to in-transit nodes.

Methods: Retrospective database and medical records were reviewed from October 21, 1993, to November 19. 1999. At the UCSF Melanoma Center, patients with tumor thickness > 1 mm or < 1 mm with high-risk features are managed with preoperative lymphoscintigraphy, selective SLN dissection, and wide local excision.

Results: Thirty (5%) out of 557 extremity and truncal melanoma patients had in-transit SLNs. Three patients had positive in-transit SLNs and negative SLNs in the regional nodal basin. Two patients had positive in-transit and regional SLNs. Three patients had negative in-transit SLNs but positive regional SLNs. The remaining 22 patients were negative for in-transit and regional SLNs.

Conclusions: In-transit SLNs may harbor micrometastasis. About 10% of the time, micrometastasis may involve the in-transit and not the regional SLN. Therefore, both in-transit and regional SLNs should be harvested.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Extremities / pathology*
  • Humans
  • Immunohistochemistry
  • Lymph Node Excision
  • Lymphatic Metastasis / pathology*
  • Melanoma / pathology*
  • Radionuclide Imaging
  • Sentinel Lymph Node Biopsy
  • Skin Neoplasms / pathology*
  • Thorax / pathology*