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