Lymph node dissection in cutaneous melanoma: Surgical and oncological implications

The concept of Sentinel Lymph Node Dissection (SLND) has strongly influence d the surgical approach towards primary melanoma in the last decade. Initia ted by the disappointing results of elective lymph node dissection (ELND) i n this malignancy, the concept of analyzing the first draining lymph node ( Sentinel) of a regional basin was developed as a diagnostic means to avoid unnecessary ELND in case of negative SLNs. According to recent standards de tection of the SLN should be per-formed by a triple approach: injection of 90 nm Technetium and patent blue in the periphery of the primary melanoma, and intra operative tracing of radioactivity with the aid of a hand-held ga mma probe. Histopathological examination of alternating series sections of the whole lymph node appears to be the best analytic approach. Molecular bi ologic procedures such as tyrosinase RT-PCR are time-consuming to perform a nd produce contradictory results. SLND for cutaneous melanoma is an interdi sciplinary diagnostic approach involving surgery, dermatology, pathology, a nd nuclear medicine. In spite of a variety of published promising results d erived from clinical trials ranging from a few dozens to several hundred in cluded patients the diagnostic and prognostic value of SLND remains to be c onfirmed by ongoing controlled prospective clinical trials. At this stage, SLND can by no means be considered a therapeutic procedure. These aspects h ave to be kept in mind when informed consent is obtained from patients as w ell as in the individual determination of the risk-benefit ratio.