Sentinel node biopsy in melanoma

There has, for a long time, been an ongoing discussion on whether the proph ylactic removal of lymph nodes ("elective lymph node dissection") is of ben efit for melanoma patients. More recently, "selective" lymphadenectomy ("se ntinel node biopsy", SNB) has been proposed to evaluate the status of the f irst draining lymph node ("sentinel node") of the regional basin. Several s tudies now demonstrate that the sentinel node evaluation for underlying met astatic disease reflects the status of the entire lymph node region and is therefore a useful prognostic factor. A multi-institutional study highlight ed SNB status as the most significant prognostic factor, superior to measur ement of tumor thickness in primary melanoma. Different techniques to detec t micrometastasis within the lymph node are under current evaluation. Histo logy and immunohistology using antibodies against melanoma-associated antig ens are routinely performed in SNs. The clinical value of reverse-transcrip tase polymerase chain reaction (RT-PCR)based search for minimal melanoma di sease in lymph nodes remains unclear.