Role of sentinel node biopsy in the management of malignant melanoma

The use of elective lymph node dissection for intermediate-thickness melanoma has remained controversial. The technique of sentinel node biopsy (intraoperative lymphatic mapping and selective lymphadenectomy) has been developed in an attempt to identify patients who may benefit from an elective node dissection while sparing patients without occult metastases the morbidity of an elective lymphadenectomy. Current methods of performing a sentinel node biopsy include both a dye and radiolabeled technique. Although the accuracy of sentinel node biopsy for identifying nodes at risk for occult metastases has been demonstrated, a survival benefit from dissection of nodal basins that contain occult metastases remains to be determined. This article reviews the basis for, technical considerations of, and surgical results with selective lymphadenectomy in an attempt to clarify the role of this modality in the management of patients with cutaneous melanoma.