MINIMAL-ACCESS SURGERY FOR STAGING OF MALIGNANT-MELANOMA

Objective: To develop a simple, minimally invasive technique of determ ining whether regional node metastasis has occurred in patients with m elanoma. Setting: Teaching hospital tertiary care and private practice settings. Patients: Between February 1993 and October 1994, 121 patie nts with invasive malignant melanoma and clinically negative lymph nod es were enrolled in this clinical trial. Design: Consecutive sample cl inical trial. Within 24 hours prior to lymph node resection, a radioac tive tracer was injected into the dermis around the site of the primar y melanoma. Forty-four patients also had blue dye injected immediately prior to surgical resection. Measurement of radioactivity in the lymp h nodes and surgical localization were made using a handheld gamma det ector. Radiolabeled nodes were selectively removed with the least diss ection possible. In patients with pathologically positive radiolabeled nodes, regional lymphadenectomy was performed. Outcome Measures: Succ essful identification of radiolabeled sentinel lymph nodes, correlatio n of radiolabeling with injection of blue dye, and regional node recur rence rate. Results: Surgeons successfully resected the radiolabeled s entinel lymph nodes in 118 (98%) of 121 patients. One hundred percent of blue-stained lymph nodes were successfully radiolabeled. Fifteen pa tients had pathologically positive sentinel lymph nodes. In 10 patient s, the sentinel node was the only node with metastasis. Two systemic a nd one regional node recurrences occurred during a mean follow-up of 2 20 days. Conclusions: Selective gamma probe-guided resection of the ra diolabeled sentinel lymph node is possible in over 95% of patients wit h melanoma. This technique offers a simple and reliable method of stag ing of regional lymph nodes in these patients without performing a reg ional lymphadenectomy.