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Sentinel Lymph Node Concept and Its Role in the Management of Melanoma Patients

Melanoma is still one of the most life threatening tumors throughout the world. In the United States of America, its mortality rate has raised by 191% in men and 84% in women in the past forty years. It is mainly a cancer of light-pigmented persons like European populations. The incidence and mortality rates have increased substantially during the past decade, although there are extreme variations in the melanoma rates among different countries. Cutaneous melanoma can spread unpredictably and widely through the lymphatics. Identification of patients with occult melanoma metastases is important for accurate staging, treatment planning and prognosis. Based on the AJCC Melanoma Database, the most important prognostic factor in overall survival is melanoma thickness, however, the revised staging system recognizes the presence of metastases in regional lymph nodes as an independent powerful prognostic factor in the 5-year survival rate in stage II and III. Melanoma has a variable lymphatic drainage pathway, particularly those lesions located in the trunk, head and neck. In the past 15 years, a novel approach has been introduced in the management of skin melanoma. As the result of modern nuclear medicine techniques, identification of sentinel lymph node (SLN) by lymphoscintigraphy (LS) and sentinel lymph node biopsy (SLNB) using hand held gamma probe has become a standard procedure. In the early stage disease (AJCC I and II) and intermediate tumor thickness (1.2-3.5 mm), LS with SLNB is the method of choice for nodal staging and to define further surgical procedure, although in melanoma thinner than 1 mm surgical management of regional lymph nodes is still controversial. The overall conclusion from more than 1500 articles published during the last decade is that LS followed by SLNB with selective lymph node dissection in patients with cutaneous melanoma is still only of prognostic value, although it identifies patients with nodal metastases whose survival can be prolonged by immediate lymphadenectomy. Therefore, the AJCC staging system continues to consider micrometastases detected only by immunohistochemistry or polymerase chain reaction to be N0 disease. This article brings a review of current concepts and utility of LS and SLNB in cutaneous melanoma.

Sentinel lymph node ; melanoma

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