The Evolution of the Sentinel Node Biopsy in Melanoma

Area of Science:

• Oncology
• Dermatology
• Surgical Oncology

Background:

• Adjuvant therapy for melanoma has been revolutionized by immune-checkpoint inhibitors and targeted therapies.
• Management of regional lymph nodes in cutaneous melanoma is evolving due to new clinical trials and improved adjuvant treatments.

Purpose of the Study:

• To review the evolution of sentinel lymph node biopsy (SLNB) in cutaneous melanoma.
• To summarize key clinical trials influencing current practice guidelines for lymph node management in melanoma.

Main Methods:

• Literature review of practice-changing clinical trials.
• Analysis of the impact of adjuvant therapy on regional lymph node management.

Main Results:

• Wide local excision (WLE) remains standard for primary cutaneous melanoma.
• Large multicenter studies indicate no overall survival benefit from completion lymph node dissection (CLND) after a positive SLNB.

Conclusions:

• Controversy persists regarding patient selection and clinical decision-making for CLND after positive SLNB.
• The changing adjuvant treatment landscape necessitates a re-evaluation of SLNB's role and subsequent management strategies.