American Association of Plastic Surgeons

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Melanoma Lymphatic Drainage Patterns Identified by Tilmanocept
Daniel M. Balkin, MD, PhD1, Frederick Wang, MD1, Cristina O'Donoghue, MD, MPH2, Emily M. Balkin, MD1, Caitlin Porubsky, DO3, Jaime L. Montilla-Soler, MD2, Vernon K. Sondak, MD2, Max C. Wu, MD4, Donald M. Torre, CNMT4, Mohammed Kashani-Sabet, MD4, Jonathan S. Zager, MD, FACS2, Stanley P L Leong, MD, MS, FACS4.
1University of California, San Francisco, San Francisco, CA, USA, 2Moffitt Cancer Center, Tampa, FL, USA, 3Philadelphia College of Osteopathic Medicine, Roswell, GA, USA, 4California Pacific Medical Center, San Francisco, CA, USA.

PURPOSE
[99mTc] Tilmanocept is a radiopharmaceutical employed for sentinel lymph node (SLN) mapping unique in its ability to discern whether a single or multiple independent SLNs exist based on its designed targeting construct. In this study, Tilmanocept is used to determine the number of SLNs in melanoma patients to guide SLN detection.
METHODS
Multi-center retrospective review of patients with cutaneous melanoma undergoing SLN biopsy using Tilmanocept between 01/2008 - 08/2014. Data analyses included descriptive statistics, t-tests, Fisher's exact tests, Chi-square tests & logistic regression.
RESULTS
573 patients formed the patient cohort, mean age was 60.3 +/- 16.6 years & 62.5% male. Primary tumor sites included: 33.2% trunk, 27.3% head/neck, 18.5% lower extremity & 20.7% upper extremity. Median of 3 (range 1-28) SLNs were identified and resected following the rule of 10% or 3-sigma. Overall, 83.4% of patients had >1 SLN identified by Tilmanocept. Patients with >1 SLN were more likely to have a positive node (p=0.008), younger (p =0.001), higher pathologic AJCC tumor stage (p=0.018) & higher Clark level (p=0.031). Additionally, >1 SLN was associated with tumor location (p<0.001). In a multivariate model, age, tumor location & Breslow depth were significantly associated with >1 SLN. A total of 17.6% of patients (101/573) had a positive SLN with an overall positive SLN rate of 6.2% (178/2890). Moreover, positive SLN status was significantly associated with younger age, greater Breslow depth, mitosis rate, higher AJCC tumor stage, ulceration, microsatellitosis, & angiolymphatic invasion.
CONCLUSIONS
Tilmanocept detects multiple SLNs in the majority of melanoma patients.


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