Sentinel lymph node excision in cutaneous malignant melanoma (detected by biopsy!). However, lady had excision of lesion thought to be neurofibroma. Final histology and IHC established that it is malignant melanoma. I have scar of previous excision which need revision surgery. Is sentinel lymph node excision a good prognostic and treatment decision maker procedure here?
Please share experience.
Thanks for this nice quesion:
The answer is:
Method that may be used to identify patients who would benefit from LN dissection, while sparing others an unnecessary operation.
1. Thin lesions (less than 1 mm), the tumor cells are still localized in the surrounding tissue, and the cure rate is excellent with wide excision of the primary lesion; therefore removal of regional LNs is not beneficial.
2. Sentinel lymphadenectomy for malignant melanoma is beneficial (widely accepted).
The sentinel node may be preoperatively located with the use of a gamma camera, which identifies the radioisotope injected into the primary lesion. **Preoperative identification (by radioisotope & gamma camera) or intraoperative mapping with 1% isosulfan blue dye injection may be equally effective.
3. Lesions with intermediate-thickness tumors (T2 and T3, 1 to 4.0 mm) and no clinical evidence of nodal or metastatic disease, the use of prophylactic dissection (elective LN dissection on clinically negative nodes)→ may decrease the recurrence rate (as 25 to 50% of clinically -ve LN specimens found to contain micrometastases).
4. If micrometastasis is identified in the removed node by frozen-section examination, a complete LN dissection is performed.
5. Lesions deeper than 4 mm, it is highly likely that the tumor cells already have spread to the regional LNs and distant sites. Removal of the melanomatous LNs has no effect on survival (Not benifecial).
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