PRIMARY THERAPY OF MALIGNANT MELANOMAS - SENTINEL LYMPHADENECTOMY

Background Each melanoma is drained by one or, occasionally, several i ndividual lymph nodes within the nearest lymph node region (sentinel l ymph node). Objective By histopathologic examination of the removed se ntinel lymph node (SLN), it is possible to select patients clinically according to stage I or II (UICC classification), but who, microscopic ally, represent stage III. Methods Sentinel lymphadenectomies (SLNEs) were performed initially by the vital blue dye technique, and later by gamma-probe guidance only. The removed SLNs were examined by hematoxy lin and eosin as well as immunohistochemical stains (S100, and HMB 45) . Results We have performed 115 gamma-probe-guided SLNEs in 100 patien ts. The SLN could be found in all cases. In pT3 + 4 melanomas, 27.5% o f the SLNs were positive; in only one patient with a pT2 tumor were mi crometastases found. Conclusions gamma-Probe-guided SLNE is a reliable procedure with minimal complications that should be performed in all pT3 + 4 (intraoperative frozen section histology) melanomas without cl inically evident metastases.