Sentinel lymph node dissection for primary cutaneous melanoma: A communityhospital's initial experience

Management of the regional lymph nodes remains the most controversial aspec t of treating patients with intermediate-thickness cutaneous melanoma. Pros pective studies have failed to demonstrate a significant survival advantage for patients undergoing elective lymph node dissection, The sentinel lymph node dissection (SLND) technique has been proposed as a method of accurate ly identifying patients with occult metastases in whom a regional lymph nod e dissection would be indicated. The majority of studies evaluating this te chnique have come from academic centers, most with dedicated melanoma clini cs. This report describes the initial experience with SLND at a community h ospital. Fifteen patients with intermediate-thickness primary cutaneous mel anoma underwent preoperative lymphoscintigraphy with 99Tc-sulfur colloid. I n addition, intraoperative lymphatic mapping using intradermally injected i sosulfan blue was performed. Dissection was guided by radioactivity levels tin counts per second) as measured by a hand-held gamma probe, The resected lymph node or nodes were evaluated for micrometastases using routine hemat oxylin and eosin staining and immunohistochemistry with S-100 and HMB-45. A ll patients were followed clinically for any evidence of recurrence, A sent inel node(s) was identified on preoperative lymphoscintigraphy in all 15 pa tients (100%). A single sentinel node was identified in 11 of 15 (73%), two nodes in 3 (20%), and one node in 1 (6.7%). The hand-held gamma probe read ing correlated well with the site marked the "hot spot" (600-15,320 cps for the hot spot versus 10-350 cps for background). The sentinel lymph node wa s successfully identified and resected in all 15 patients. Blue-stained lym phatics and/or lymph nodes were present in 8 of 15 (53%) eases. Histopathol ogy was negative for evidence of occult micrometastases in all patients. At mean follow-up of 221 days, all 15 patients remain with no evidence of dis ease. The outcomes for mapping and harvesting the sentinel node at a commun ity institution compare favorably with results at major academic institutio ns, SLND may therefore be offered to patients with intermediate-thickness c utaneous melanoma in the community hospital setting with regional lymph nod e dissection and adjuvant interferon alpha-2b as options for patients with nodal micrometastases.