SENTINEL NODE DISSECTION IN THE TREATMENT OF MELANOMA - REPORT OF 3 CASES AND REVIEW OF THE LITERATURE

BACKGROUND. Elective lymph node dissection for treatment of cutaneous malignant melanoma is controversial. Sentinel node dissection involves removing the primary lymph node in a nodal basin that drains a partic ular cutaneous lesion. Theoretically, this node would collect regional metastases first. Therefore, if this node is negative, the chances ar e low that the melanoma would have spread either systemically or to ot her nodes within this basin. Removing one node would decrease the morb idity associated with radical lymph none dissection. However, the actu al risk of widespread metastases in sentinel node-negative patients is yet to be determined, pending results of large, multicenter studies c urrently under investigation. OBJECTIVE. TO present three cases of int ermediate thickness cutaneous melanoma treated with selective lymph no de dissection and to review the techniques of selective lymphadenectom y and lymphoscintigraphy. METHODS. In a nonrandomized prospective eval uation, patients with intermediate depth melanomas or in transit metas tases without signs of systemic disease were given the opportunity for further investigation by sentinel node dissection to determine if add itional lymph node dissection or adjunctive therapies would be advanta geous. RESULTS. All three patients had negative sentinel node examinat ions. Two are without visceral or nodal metastases 1 year after the pr ocedure. The third had in-transit metastases from the outset, had in-t ransit metastases on sentinel node/lymphatic examination, and now has systemic cutaneous metastases. Complications of sentinel node dissecti on were limited to transient postoperative lymphedema of the extremiti es and transient seroma formation. No postoperative wound infections o r permanent nerve damage were noted. CONCLUSIONS. Our preliminary find ings in this limited series suggests that sentinel node dissection app ears to be a procedure of low morbidity and relatively high predictive value. (C) 1997 by the American Society for Dermatologic Surgery, Inc .