Regional lymphadenectomy in the treatment of patients with melanoma skin with metastases in the sentinel lymph nodes

Abstract

Regional recurrences are one of the most common first manifestations of progression of clinically localized cutaneous melanoma. They are caused by subclinical metastases in the lymph nodes. Biopsy of the sentinel lymph nodes is the most effective method of detection of hidden regional metastases. It allows to appropriately increase the volume of surgical treatment prior to dissection of the affected lymph collector and perform adjuvant therapy with the most effective drugs. This, in its turn, allows for significant improvement of regional and systemic control of the disease and long-term treatment outcomes.Data obtained in several randomized trials on the effectiveness of lymph node dissection in patients with sentinel lymph node metastasis showed that this procedure significantly improves regional control of the disease but does not affect long-term treatment outcomes. Additionally, some studies showed that assignment of responsibility for regional control to adjuvant therapy does not meet the expectations. Therefore, the most effective method of regional control of cutaneous melanoma is surgery. All of these studies show that it is necessary to develop criteria for identification of patients with high risk of metastases in the non-sentinel lymph nodes who require lymph node dissection for regional disease control and creation of the best conditions for adjuvant systemic therapy. This requires identification of predictors of multiple involvement of regional lymph nodes justifying indications for radical lymph node dissection. Studies in this area are being performed but their results are ambiguous and sometimes contradictory.Aim. To evaluate the effectiveness of lymph node biopsy and radical lymph node dissection in patients with cutaneous melanoma and subclinical involvement of the sentinel lymph node.