Sentinel lymph node biopsy in patients with Stage I/II melanoma: Clinical experience and literature review

Abstract

Sentinel node lymphadenectomy can be better accomplished when both procedures (lymphatic mapping with Patent Blue-V and RGS) are used because the two methods look quite complementary. In fact, the use of the radiocolloid mapping allows to detect a hot spot in the regional basin prior to making the skin incision in order to perform a minimal invasive access, and it may also more accurately differentiate the true sN from a secondary echelon node (non-sN). The use of frozen section examination should be restricted to patients with pT(3)-pT(4) primary melanoma, due to the higher sensitivity and benefit in terms of avoiding a two-stage operative procedure.

Staging patients with cutaneous malignant melanoma by same-day lymphoscintigraphy and sentinel lymph node biopsy: A single-institutional experience with emphasis on recurrence

“…As the latter happened in only a single case (0.35%), we find the same-day procedure reliable. However, some centers reported a high success rate with lymphoscintigraphy performed one to several days before operation [5,7,11] (Table V).…”

“…Other centers have performed elective lymph node dissection (ELND) in patients without clinically evident nodal disease, that is, without prior selection of patients with SLN biopsy, and found lymph node metastases in up to 25% [5,6,16,18,19]. The effect of ELND on overall survival rate remains controversial [14,20,21], although some have found reduced mortality in subgroups [20,22,23], and patients with detected micrometastases proved to have a better 10-year survival than patients treated for macrometastases [2,[24][25][26].…”

“…Several features may influence the false negative rate [5,27,29]. Technical failure could be one explanation of regional lymph node recurrence due to imprecise technique.…”

“…From most lymph nodes, 18 serial sections were cut, 6 at each step, leaving 9 unstained slides for possible application of additional markers. Intraoperative frozen section appears to have an unsatisfactory low sensitivity of only 50-60% [5,16] and, consequently, was not performed.…”

“…The sentinel lymph node (SLN) biopsy technique has emerged as a minimally invasive approach to accurate nodal staging; avoiding unnecessary lymphadenectomy in patients with histologically negative SLNs. However, different techniques have been employed and regional recurrence remains a problem [5][6][7][8][9][10][11]. In this article, we present a singleinstitutional experience with the first 278 consecutive patients being treated with SLN procedures including lymphoscintigraphy followed on the same day by radioprobe-guided surgery.…”