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Is Sentinel Lymph Node Excision Useful in Predicting Spread of Squamous Cell Skin Cancer?

By: Joseph Fanelli
Posted: Wednesday, April 24, 2019

The clinical utility of the extirpation of the sentinel lymph nodes appears to be limited in patients with high-risk cutaneous squamous cell carcinoma, according to study findings presented in the European Journal of Cancer. Sentinel lymph node excision is not a reliable diagnostic approach to evaluate the risk of future systemic carcinoma spread and the development of distant metastases in these patients, determined Philipp Jansen, MD, of the University Hospital Essen, Germany, and colleagues.

“Novel diagnostic approaches for patients with high-risk cutaneous squamous cell carcinoma should be evaluated,” the authors concluded. Researchers conducted an ambidirectional cohort study with 114 patients who underwent sentinel lymph node excision, with a median follow-up of 23.7 months. Of the patients, 89 were men, and 25 were women.

A multivariable analysis revealed that histopathologic detection of ulceration (hazard ratio = 2.9), perineural growth (hazard ratio = 3.0), and clinical utility occult sentinel lymph node metastases (hazard ratio = 10.7) were strongly associated with the future occurrence of distant metastases. Dr. Jansen and colleagues noted a 50% positive predictive value for patients in whom sentinel lymph node metastasis was detected to develop distant metastases. However, in seven patients, distant metastases also occurred when histopathologic sentinel lymph node evaluation exhibited no evidence of metastases.

The authors did acknowledge limitations to their study. “Although we present the largest cohort study of [high-risk cutaneous squamous cell carcinoma] to date, the study size is still too small to provide precise estimates of diagnostic indices and hazard ratios,” they noted.

Disclosure: The study authors’ disclosure information may be found at ejcancer.com.



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