Role of sentinel lymph node biopsy as a staging procedure in patients with melanoma: A critical appraisal

Abstract

Worldwide, sentinel node (SN) biopsy for accurate staging is now part of the standard work-up of patients with melanomas ≥1.0 mm Breslow thickness, as it is for staging patients with breast cancer. Nuclear medicine imaging and surgical techniques have evolved to such a degree that a SN can be identified and removed in virtually every patient. Nevertheless, some opposition to a routine SN biopsy remains, perhaps due to a failure to appreciate the serious implications of incomplete or inaccurate staging. Guided by a critical appraisal of the available evidence, this review elucidates the definition of an SN, discusses the sensitivity and specificity of the information it provides, emphasises that it is a minor staging procedure that can lead to improved survival when followed by appropriate therapy, and explains the necessarily unconventional and complex design of the only randomised trial that addresses this subject. It also describes other benefits and risks of an SN biopsy and outlines its role in current melanoma management.

Does very early timing of lymph node surgery after resection of the primary tumour improve the clinical outcome of patients with melanoma?

“…4,5 Considering the predictable manner in which CM usually spreads, starting from the SLN, prompt definitive surgical management after initial diagnosis may seem to be advantageous for preventing disease relapse and MSS. [1][2][3][4][5] However, if the SLN is infiltrated by tumour cells, a delay in its removal may boost antimelanoma immune responses following resection of the primary tumour, thereby actually improving patient outcome. Several research groups have addressed the question as to whether the time interval between removal of the primary tumour and SLNB affects clinical outcome.…”

“…However, on an individual basis, SLNB can also be recommended for thinner melanomas (0.75 mm) when other risk factors are present, such as ulceration, age > 40 years and increased mitotic index. Based on the current evidence, SLN status has been shown to be the strongest predictor of MSS 4,5 …”

“…Based on the current evidence, SLN status has been shown to be the strongest predictor of MSS. 4,5 Considering the predictable manner in which CM usually spreads, starting from the SLN, prompt definitive surgical management after initial diagnosis may seem to be advantageous for preventing disease relapse and MSS. [1][2][3][4][5] However, if the SLN is infiltrated by tumour cells, a delay in its removal may boost antimelanoma immune responses following resection of the primary tumour, thereby actually improving patient outcome.…”

Metastatic melanoma vs lymphoma. Using a sentinel lymph node biopsy a diagnostic tool

“…Sentinel lymph node biopsy (SLNB) and ultrasound/fine needle aspiration cytology SLNB has a high sensitivity and specificity for diagnosing subclinical regional lymph node involvement in metastaic melanoma [1]. Ultrasound and fine needle aspiration cytology (FNAC) is a recognized alternative method for pre-operatively identifying metastatic spread, however, this modality has reduced sensitivity compared with SLNB [2, 3].…”