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Wide Local Excision Before Sentinel Lymph Node Biopsy in Melanoma
Michael Tassavor1, Madalyn Bland1, Olivia Goldenberg2
1The Skin Cancer Center, Cincinnati, Ohio.
Summary
Delaying wide local excision for thick melanomas is not supported by evidence. Sentinel lymph node biopsy can be performed without compromising melanoma excision outcomes.
Area of Science:
- Oncology
- Surgical Oncology
- Dermatology
Background:
- Current guidelines recommend delaying wide local excision (WLE) for thick melanomas until after sentinel lymph node biopsy (SLNB).
- This practice is based on the assumption that prior excision might compromise SLNB accuracy.
Purpose of the Study:
- To critically evaluate the scientific literature regarding the necessity of delaying WLE for thick melanomas.
- To determine if a scientific basis exists for the current guideline of delaying WLE until SLNB completion.
Main Methods:
- A comprehensive narrative review of existing medical literature was conducted.
- All relevant studies addressing the timing of WLE in relation to SLNB for thick melanomas were examined.
Main Results:
- The review found no evidence to suggest that prior wide local excision compromises sentinel lymph node identification.
- Unsubstantiated claims exist regarding potential false negatives in SLNB due to large rotation flaps used in prior excisions.
Conclusions:
- There is no scientific rationale for delaying wide local excision of thick melanomas until after sentinel lymph node biopsy.
- Current guidelines regarding the delay of WLE for thick melanomas should be re-evaluated based on available evidence.
