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Reducing workload in malignant melanoma sentinel node examination: a national study of pathology reports from 507 melanoma patients
  1. Carina Mellemgaard1,2,
  2. Ib Jarle Christensen3,
  3. Giedrius Salkus4,
  4. Pia Wirenfeldt Staun5,
  5. Niels Korsgaard6,
  6. Kim Hein Lindahl7,
  7. Mathilde Skaarup Larsen3,
  8. Siri Klausen3,
  9. Johanne Lade-Keller1
  1. 1 Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
  2. 2 Aarhus University, Aarhus, Denmark
  3. 3 Department of Pathology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
  4. 4 Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
  5. 5 Department of Pathology, Odense University Hospital, Odense, Denmark
  6. 6 Department of Pathology, Hospital South West Jutland, Esbjerg, Denmark
  7. 7 Department of Pathology, Lillebaelt Hospital, Vejle, Denmark
  1. Correspondence to Dr Carina Mellemgaard, Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; carinamellemgaard{at}


Aims Even though extensive melanoma sentinel node (SN) pathology protocols increase metastasis detection, there is a need for balancing high detection rates with reasonable workload. A newly tested Danish protocol recommended examining nodes at six levels 150 µm apart (six-level model) and using SOX10 and Melan-A immunohistochemistry (IHC). We explored if a protocol examining 3 levels 300 µm apart (three-level model) combined with IHC would compromise metastasis detection. The study aim was to optimise the protocol to reduce workload without compromising detection rate.

Methods 8 months after protocol implementation, we reviewed the pathology reports of SNs from 507 melanoma patients nationwide, including 117 SN-positive patients. Each report was reviewed to determine histopathological features, including detection of metastasis, exact levels with metastasis, exact levels with metastasis >1 mm in diameter and IHC results.

Results The six-level model detected metastases in 23% of patients, whereas the three-level model would have detected metastases in 22% of patients. The three-level model would have missed a few small metastases (n=4), measuring <0.1 mm, 0.1 mm, 0.4 mm and 0.1 mm, respectively. The six-level model detected metastases >1 mm in 7% of patients. One of these metastases (measuring 1.1 mm) would have been detected by the three-level model, but not as >1 mm. SOX10 and Melan-A had equal sensitivity.

Conclusions Reducing the number of levels examined to three levels 300 µm apart combined with IHC does not have significant impact on metastasis detection rate, and we will therefore recommend that the future melanoma SN guideline takes this into consideration to reduce overall workload.

  • Sentinel Lymph Node
  • Neoplasm Metastasis

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Handling editor Runjan Chetty.

  • Contributors Conception or design of the work: JL-K, SK and MSL. Data collection: JL-K. Data analysis and interpretation: JL-K, CM, IJC and SK. Drafting the article: CM, JL-K, SK ad IJC. Critical revision of the article: all authors. Final approval of the version to be published: all authors. Guarantor: JL-K.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.