T. Cottingham et al., SENTINEL NODE DISSECTION IN THE TREATMENT OF MELANOMA - REPORT OF 3 CASES AND REVIEW OF THE LITERATURE, Dermatologic surgery, 23(2), 1997, pp. 113-119
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
.