Journal des essais cliniques sur le cancer

We report on a case of a 68-year-old man with metastatic melanoma presenting with interstitial pneumonitis following initiation of pembrolizumab, in the setting of occult sarcoidosis. There have been no previous reports on pembrolizumab inducing a flare of sarcoidosis. This patient was managed with high dose steroids with improvement in his respiratory symptoms. The use of immunotherapy in the management of various solid tumours is increasing and clinicians from different specialities need to be aware of the potential toxicities associated with this class of drugs that can affect multiple organs.

Purpose: The treatment of vulvar cancer remains surgical; however, as surgical treatment has evolved the surgical morbidity has decreased with the use of minimally invasive technology. Sentinel lymph node biopsy, which has been validated in breast cancer and melanoma, has been similarly investigated in vulvar cancer. This review summarizes the current evidence supporting sentinel lymph node biopsy in vulvar cancer.

Findings: Compared to inguinofemoral lymphadenectomy sentinel lymph node biopsy has a sensitivity of 87-92% for the detection of vulvar cancer and a false negative predictive value of 2.0% in tumors ≤ 4 cm. Nodal recurrences following sentinel lymph node biopsies are comparable to recurrence rates following inguinofemoral lymphadenectomy. However complications after sentinel lymph node biopsy, including lymphedema, cellulitis and wound breakdown, are much lower.

Conclusions: Sentinel lymph node dissection is safe and feasible in select patients with vulvar cancers measuring ≤ 4 cm with bilateral SLN dissection for midline lesions. Procedures should be performed at centers with sufficient volume and with radiologists, surgeons and pathologists trained in a sentinel lymph node protocol.