Sentinel node biopsy in cutaneous melanoma

Abstract

Status of the regional lymph nodes is a strong prognostic factor in patients with cutaneous malignant melanoma (CMM) and can be assessed by sentinel lymph node biopsy (SLNB). We present our technique of preoperative lymphatic mapping and intraoperative vital dye and handheld gamma probe. Our results and three years follow-up of its routine use in 198 patients with verified primary CMM are presented. Median follow-up time was 24 months (range 1–47). Metastatic regional lymph node disease was found by SLNB in 61 patients (31%) and additional metastatic nodes were found by formal node dissection in 30% of these cases. Complications were relatively mild but included one case of lymphoedema in a node negative patient. By follow-up, 13% had developed a recurrence including 26% of node positive patients and 8% of node negative patients. Mortality was also substantially higher in node positive cases with 18% dying in the follow-up period and 3% in the node negative group. The SLNB procedure was associated with a false negative rate of 8%. Using the presented technique, we found that SLNB was a useful procedure for staging patients with CMM and for selecting patients for more extensive metastatic screening and inclusion in trials of adjuvant treatments.

• Melanoma
• sentinel lymph node biopsy
• staging
• prognosis
• recurrence