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Detection of melanoma micrometastases in sentinel nodes - the cons
Johannes H W de Wilt1, Alexander C J van Akkooi, Cornelis Verhoef
1Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, P.O. Box 5201, 301 Groene Hilledijk, 3008 AE, Rotterdam, The Netherlands. j.h.w.dewilt@erasmusmc.nl
Abstract:
The sentinel node (SN) procedure in melanoma patients is important for prognostic information, but has no impact on survival. Micrometastases are identified in approximately 20% of the SNs. When a Completion Lymph Node Dissection (CLND) is performed for positive SN, additional non-SN lymph node involvement is also approximately 20%. Several classification criteria have been proposed to identify patients with SNs without a risk for additional nodes or a good prognosis. Micro anatomic analyses of metastatic SNs suggest that patients with sub-micrometastases (<0.1mm) in the SN may be judged as SN negative. Patients with this limited tumor burden in their SN have an excellent prognosis and are highly unlikely to benefit from CLND. New techniques such as ultrasound of the lymph nodal basin can be promising as an alternative for SN biopsy.
