Standard and nonstandard applications of sentinel node-guided melanoma surgery

Identification and histologic study of the sentinel node (SIV) is an accept able, yet not firmly established, guide for treating intermediate-thickness melanoma. This study widens the range of applications of this technique. W e included 97 patients with intermediate-thickness melanoma lesions or lesi ons for which there is no standard treatment. Fifty-six underwent preoperat ive lymphoscintigraphy, and all underwent intraoperative lymphatic mapping (IOLM) using blue dye, followed by frozen section study and total node proc essing by serial sections. Elective lymph node dissection was performed in cases of metastasis to the sentinel node or technical failures with high ri sk. Four categories were defined: (A) intermediate-thickness lesions (mean 2.27 mm) (n = 45); (B) thin lesions (mean 1.14 mm) with risk factors of reg ional failure (n = 27); (C) lesion thickness close to but more than 4 mm (n = 10); and (D) lesions of undetermined thickness (n = 15). Median follow-u p was 30 months (range 13-51 months). Intraoperative lymphatic mapping succ essfully identified the sentinel node (SN) in 93% of basins explored. Metas tases were detected in 11 SNs. There were three lymph basin recurrences in patients with previously negative SNs, all salvaged by therapeutic Lymph ba sin dissection and are NED (no evidence of disease). Two SN+ patients had s ystemic recurrences; one died of his disease, and the other is alive with d isease. One SN- patient died NED owing to other cause. This technique Spare d 83% of category A patients from lymph node dissection. It allowed better staging and better decision making for treatment in categories B and D; and it prevented early regional recurrences in category C patients. Intraopera tive lymphatic mapping with SN guidance is a novel, low-morbidity approach applicable and advantageous for a wide range and subgroups of melanoma pati ents.