A selective approach to regional lymphatics in melanoma

The management of regional lymphatics in patients with melanoma has evolved over the past several decades from delayed lymphadenectomy, to elective resection, to the current approach which utilizes sentinel lymph node mapping to accomplish a selective approach to performing lymphadenectomy. Sentinel lymphatic mapping allows for an opportunity to demonstrate regional lymphatic disease prior to the development of lymphadenopathy. Complete resection of a nodal basin can be reserved for patients with documented disease in a sentinel node while patients with a negative sentinel node can avoid an unnecessary and potentially morbid surgery. The preliminary results of sentinel node mapping at Ochsner Medical Institutions reflect an outstanding ability to demonstrate the sentinel node in patients with trunk and extremity melanoma when radioactive colloid is used in combination with a vital blue dye. The results of sentinel node mapping in patients with head and neck melanoma have not been as reliable and require additional refinements of technique.