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Title: Lymphatic mapping and occult nodal metastasis in melanoma
Author: Wiener, Martin
ISNI:       0000 0004 5921 3377
Awarding Body: University of Sheffield
Current Institution: University of Sheffield
Date of Award: 2016
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Around 20% of patients, diagnosed with a clinically localized primary cutaneous melanoma, have occult lymph node metastases. Lymphatic mapping and sentinel node biopsy, using pre-operative lymphoscintigraphy, intra-operative blue dye injection and gamma probe localization, in most cases identifies the node or nodes most likely to contain occult metastases, if present. The presence or absence of such metastases is the most powerful prognostic indicator in this group of patients. However, a number of other factors related to the patient and the primary melanoma can be used to determine prognosis. It is therefore important that the quality of lymphatic mapping is maximized and information gained from sentinel node biopsy is used to best effect, so that advice and treatment can be tailored to the individual patient. The studies contained within this thesis represent an attempt to improve the quality and individualization of care. The technique of lymphatic mapping using lymphoscintigraphy has been critically analysed to identify sources of inaccuracy. The frequency and causes of failure to identify sentinel nodes using lymphoscintigraphy have been determined in a large series of patients. The lymphatic drainage patterns from the head and neck have been investigated, using the forehead and its subdivisions, in order to produce new recommendations for selective neck dissection. The relative importance of clinical and pathological factors in sentinel node positive patients and the significance of nodal metastasis beyond sentinel nodes have been determined. A new prognostic classification or survival tree has been developed for patients with occult nodal metastases and then validated in a separate population. This allows four distinct prognostic groups with 5-year survival ranging from over 90% to around 20% to be identified. The prognostic groups differentiate patients who are at high and low risk of having occult distant metastases and so could be used to select patients for entry into clinical trials of adjuvant therapies as well as to determine who should receive existing adjuvant therapies. The survival tree has been compared with currently available prognostic tools with favourable results.
Supervisor: Wyld, Lynda ; Brotherston, Michael ; Thompson, John Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available