| Melanoma metastases in sentinel lymph node could be detected in imprint smears utilizing a rapid intraoperative protocol, potentially eliminating the need for an additional surgery
Sentinel lymph node (SLN) biopsy is performed commonly as a standard of care in the management of cutaneous melanoma. If SLN sentinel is positive for melanoma metastases, generally the patient undergo regional lymphadenectomy after availability of results on permanent sections at later date. This means second surgery and related drawbacks. If SLN could be evaluated intraoperatively for melanoma metastases the regional lymphadenectomy could be completed during the same surgery. Available alternative of applying immunohistochemistry on intraoperative frozen sections and using conventional immunomarkers, such as S-100 protein and HMB45, have significant limitations with compromised results. Our study showed that cohesive cells of benign capsular melanocytic nevi that were also immunoreactive with the cocktail do not exfoliate in imprint smears. None of the 7 SLNs from 7 cases with capsular nevi showed false positive results. The discriminatory immunostaining pattern with the 'MCW Melanoma Cocktail' facilitated intraoperative immunocytochemical evaluation of imprint smears of SLNs for melanoma metastases in 87.5% (7/8) of cases with positive SLN with 100% specificity and 90% sensitivity. In a majority of positive cases, a regional lymphadenectomy could have been completed during the same surgery, potentially eliminating the need for an additional surgery.
Bibliographical reference: Shidham
VB et al.: "Prevention of an additional surgery for regional
lymphadenectomy in melanoma: Rapid intraoperative immunostaining of
sentinel lymph node imprint smears", Diagn
Pathol. 2006 Sep 25;1(1):32 [Epub ahead of print]
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