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Optimal selective sentinel lymph node dissection in primary malignant melanoma

S P Leong¹, I Steinmetz, F A Habib

¹Department of Surgery, University of California/Mount Zion Medical Center, San Francisco, USA.

Archives of Surgery (Chicago, Ill. : 1960)

|June 1, 1997

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Selective sentinel lymph node (SLN) dissection using preoperative lymphoscintigraphy and intraoperative mapping is highly effective for identifying SLNs in malignant melanoma patients. This approach reliably detects microscopic melanoma in 18.4% of SLNs, guiding further treatment.

Area of Science:

Oncology
Surgical Pathology
Medical Imaging

Background:

Sentinel lymph node (SLN) dissection is crucial for staging malignant melanoma.
Accurate identification of SLNs minimizes unnecessary lymph node dissection and guides treatment decisions.

Purpose of the Study:

To evaluate the optimal method for selective sentinel lymph node dissection in primary malignant melanoma.
To determine the efficacy and safety of a combined preoperative and intraoperative mapping technique.

Main Methods:

A consecutive patient study was conducted at a tertiary care referral center.
Sentinel lymph nodes were identified using intradermal injection of technetium Tc 99m sulfur colloid and immediate injection of isosulfan blue dye.
Successful SLN identification was defined by blue dye staining, radioisotope uptake, or both.

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Main Results:

The combined mapping technique achieved a 98% success rate in identifying SLNs.
Microscopic metastatic melanoma was found in 18.4% of SLNs.
Further metastatic disease was identified in lymphadenectomy specimens of 18.2% of patients with positive SLNs.
No significant complications were reported, with low recurrence rates during a median follow-up of 463 days.

Conclusions:

The sequential combination of preoperative lymphoscintigraphy and intraoperative mapping reliably identifies regional SLNs in patients with primary malignant melanoma.
The 18.4% frequency of SLN metastasis highlights the importance of accurate staging.
Gamma-probe-guided resection effectively minimizes the extent of lymph node dissection, though further follow-up is necessary to assess long-term outcomes regarding recurrence.