SENTINEL NODE BIOPSY AND SELECTIVE DISSECTION FOR MELANOMA NODAL METASTASES

Background: Early detection of nodal metastases still represents an im portant goal in the management of melanoma patients. A sentinel node i s defined as the first colored node in the regional lymphatic basin fo llowing injection of blue dye in the site of the primary melanoma, Sen tinel node biopsy may represent a feasible technique for early identif ication of occult disease. A therapeutic dissection is then performed only in patients with proven nodal disease, thus introducing the conce pt of selective dissection. Methods: At the National Cancer Institute of Milan from February 1994 to October 1996, 74 patients with a melano ma of the trunk or limbs and without clinically detectable node metast ases were submitted to sentinel node biopsy and eventual selective dis section. Results: The sentinel node was identified in 67 patients (90% ), Nodal metastases were detected in 11 patients (16%); 5 of these wer e identified by an intraoperative frozen section examination. In all b ut one case, only the sentinel node was affected at radical dissection , incidence of positive sentinel nodes was correlated with depth of in filtration of the primary lesion. Mapped nodal basin failures were obs erved in 3 patients with negative sentinel node biopsy All patients bu t one, presenting distant metastases, are alive at this writing and fr ee of disease with a follow-up ranging from 2 to 34 months. Conclusion s: Our study adds to accumulating evidence supporting the efficacy of sentinel node biopsy In detecting occult localizations and the potenti al of the technique to better select the group of patients that may be nefit from nodal dissection.