More rational and conservative surgical strategies for malignant melanoma using lymphatic mapping and sentinel node...

Stimulated by novel lymphatic mapping techniques, the surgical care of the melanoma patient is becoming more conservative. Preoperative lymphoscintigraphy can identify all regional nodal basins at risk for metastatic disease, areas of "intransit" nodal collections, and the location and number of the primary draining nodes in relation to the rest of the nodes in the basin. Intraoperative mapping techniques, using a combination of a vital blue dye and a radioactive tracer, can then be used to harvest this first draining node, termed the sentinel node, for examination. It is clear that the most powerful prognostic factor for any solid tumor, including melanoma, is the presence or absence of regional lymph node disease. However, routine histologic examination may underestimate the number of patients with nodal disease. Serial sectioning and immunohistochemical staining, techniques that have been available for years, can increase the yield of positive dissections compared with routine histology. The selective approach to the nodal basin would allow the pathologist to be more detailed in examining the harvested sentinel node, providing more accurate staging information for melanoma.