Sentinel node staging for cutaneous melanoma in a university-affiliated community care setting

Background: The feasibility of intraoperative lymphatic mapping and sentine l lymphadenectomy (SLND) in settings other than high-volume specialized cli nics has been questioned. We sought to determine the feasibility of SLND in a university-affiliated private teaching hospital. Methods: A multidisciplinary sentinel node program was established to inclu de surgeons, nuclear medicine physicians, and pathologists. Within this pro gram, 79 patients with cutaneous melanoma underwent attempted SLND after cu taneous lymphoscintigraphy (CL), between January 1994 and December 1998. Al l sentinel nodes were examined by hematoxylin-eosin staining and determined whether negative for evidence metastatic disease by both S-100 and HMB 45 immunohistochemical staining. Results: CL was successful in 77 (97%) of 79 patients. A total of 88 lympha tic basins were found to be at risk for metastatic disease by CL. SLND was nor successful in the two patients who did not have a successful CL. Sentin el nodes were identified in all but three patients with the remaining 88 ly mphatic basins (technical success, 97%). There was one false negative in th is group of patients Conclusions: SLND is a highly accurate way of staging the regional node bas in. Our technical success rates and false-negative rates indicate the feasi bility of this approach in settings other than high-volume specialty clinic s.