Regional lymph node dissections in malignant melanoma

Considerable controversy surrounds the application of regional lymphadenect omy in the treatment of cutaneous melanoma in patients with clinically nega tive nodes; however, therapeutic lymph node dissection for clinically posit ive nodes has shown clear benefits. Opponents of elective lymph node dissec tion (ELND) for clinically negative nodes believe that because 80% of patie nts with clinical Stage I disease have histologically negative nodes at the time of resection of the primary tumor, prophylactic excision of the regio nal nodes is unnecessary. Some clinicians have failed to demonstrate a surv ival advantage for ELND. With the recent introduction of sentinel lymph nod e dissection, it may be possible to select patients who are likely to benef it from ELND. The authors recommend ELND based on the identification of met astatic cells within the sentinel lymph node in all patients with primary m elanomas with a thickness of at least 1.0 mm.