CLINICAL REPORT
671 ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Sentinel Lymph Node Biopsy in Cutaneous Squamous Cell Carcinoma Series of 37 Cases and Systematic Review of the Literature
Raphael LHOTE 1, Jérôme LAMBERT 2, Julie LEJEUNE 2, Jeremy GOTTLIEB 1, Antoine BADAOUI 3, Maxime BATTISTELLA 3, 4, Jennifer ROUX 1, Cecile PAGES 1, Laetitia VERCELLINO 5, Catherine VILMER 1, Christine LE MAIGNAN 6, Catherine ESCANDE 7, Besma MBAREK 8, Martine BAGOT 1, 4, Celeste LEBBE 1, 4 and Nicole BASSET-SEGUIN 1, 4
1
Dermatology Department, 2 SBIM, 3 Pathology Department, 5 Department of Nuclear Medicine, 6 Oncology Department, 7 Oral and Maxillofacial Surgery Department, 8 Department of Radiotherapy, Saint Louis Hospital, and 4 Paris 7 Diderot University, Paris, France
Cutaneous squamous cell carcinoma( cSSC) is one of the most common skin cancers and can lead to patient death. Early detection of node metastasis is a major goal for dermatologists and oncologists. The procedure sentinel lymph node biopsy has been proposed to improve early detection of node metastasis. The aim of this study was to evaluate the efficacy and impact of this technique on the prognosis of cSSC. A total of 37 patients( Saint Louis Hospital, Paris, France) who had undergone sentinel lymph node biopsy and 290 cases from the literature were analysed. The mean rate of positive sentinel lymph node biopsy was 0.14 [ 95 % CI 0.09 – 0.22 ]. However, relapse-free survival and overall survival were not affected by sentinel lymph node status( log-rank test; p = 0.08 and p = 0.31, respectively), suggesting that this procedure is not mandatory in the management of cSSC.
Key words: squamous cell carcinoma; sentinel lymph node; overall survival; relapse-free survival.
Accepted Apr 12, 2018; Epub ahead of print Apr 12, 2018 Acta Derm Venereol 2018; 98: 671 – 676.
Corr: Pr Nicole Basset-Seguin, Dermatology Department, Hôpital Saint Louis, APHP, 1 Avenue Claude Vellefaux, FR-75010 Paris, France. E-mail: nicole. basset-seguin @ aphp. fr
Sentinel lymph node biopsy( SLNB) is a common procedure for improving initial staging in oncology. In dermatology, SLNB is recommended for the most frequent aggressive cutaneous neoplasms, such as melanoma( 1, 2) and Merkel cell carcinoma( 3). However, due to lack of evidence, SLNB is not currently recommended by a European consensus for use in cutaneous squamous cell carcinoma( cSCC), which is a frequent and potentially aggressive skin tumour( 4). Although mortality in cSCC is lower than in melanoma or Merkel cell carcinoma, cSCC is associated with local recurrence( 4.6 %), node metastasis( 3.7 %) and distant metastasis leading to patient death( 2.1 %)( 5). Early diagnosis of nodal metastasis, which is the primary progression route for cSCC, is a major goal for dermatologists and oncologists, in order to optimize the care of these patients. Risk factors( size, thickness and invasion beyond the fat, perineural invasion, poor differentiation, head and neck location, immunosuppression)( 4 – 6) and tumour-node-metastasis( TNM) classifications( 7, 8) have been proposed to evaluate tumour prognosis.
SIGNIFICANCE
Early detection of node metastasis is a major goal in oncology. The aim of this study was to evaluate the impact of the sentinel lymph node biopsy( SLNB) procedure on the prognosis of cutaneous squamous cell carcinoma( cSSC). A series of 37 patients and 290 cases from the literature were included. Overall survival and relapse-free survival were not affected by sentinel lymph node status. The presence of a poorly differentiated tumour was the only risk factor associated with a positive SLNB, as well as with relapse. Only one histopathological risk factor, poor differentiation of the tumour, was correlated with positive SLNB results and with recurrence in the case of negative SLNB results.
SLNB efficiency was analysed in a large study( n = 847) of SCC cases in the oral cavity and oropharynx, with positive SLNB results observed in 18 – 60 % of patients with high sensitivity( 93 %)( 9, 10). SLNB was therefore proposed to complete the staging procedure for cSSC. However, the exact impact of SLNBs on cSCC remains unclear and controversial, and the procedure can result in overtreatment and higher morbidity for low-progression patients. The aim of this study was to evaluate the benefits of SLNB and the impact of SLNB results on progression and death in cSCC.
METHODS
This study combines a mono-centre retrospective series using exhaustive data and pooled analysis with a systematic literature review.
Patients
Patients were selected from the cohort of cutaneous cell carcinoma( cSCC) patients treated at the Saint Louis Hospital( Paris, France) between January 2008 and March 2014 and were followed until September 2016. Patients were selected from the Multidisciplinary Tumour Board( MTB) list, in which all patients with cSCC are reported, and cross-referenced with the list of all those who underwent a sentinel lymph node biopsy( SLNB). In our centre, SLNB procedures were offered to patients with unique cSCC TxN0M0 profiles. Main indication of SLNB procedure was patients with T2( AJCC 7 th edition( 7)) tumours. For T1 and T3 tumours, staged according to AJCC guidelines( 7), the decision to undergo SLNB was made individually after decision of the MTB. If the SLNB showed histological evidence of micro-metastases, radical lymph node dissection( RLND) of the involved basins was recommended.
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2942 Acta Derm Venereol 2018; 98: 671 – 676