Lymphatic mapping and sentinel lymph node biopsy

Malignant melanoma--cancer of the pigment cells--has the highest mortality rate of all skin cancers. With early detection and treatment, however, malignant melanoma is highly curable. Recently, diagnostic modalities for nodal involvement have been perfected, reducing the morbidity of elective lymph node dissections and rendering them unnecessary in many cases. Total lymphadenectomy procedures are being replaced by intraoperative lymphatic mapping and sentinel lymph node biopsy using gamma detector probes. This article reviews lymphatic drainage from the primary site to possible lymph node basins and selective lymph node dissection using lymphoscintigraphy and intraoperative mapping as guides. This article also includes a case study, beginning with a diagnosis of malignant melanoma and following a successful postoperative course.