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.