Sentinel node in management of malignant melanoma

OBJECTIVE: One of the most important prognostic features of malignant melanoma is the involvement of regional lymph nodes. The aim of this study is to identify the sentinel lymph node which is the first node to be involved by metastases from malignant melanoma and then decide which patients can benefit from lymph node dissection and which will only need clinical follow-up.

METHODS: Forty-four patients were included in this study from October 2000 to November 2001. The study was carried out at the St. Bartholomew's and Royal Hospital, London, United Kingdom. We undertook a pilot study of patients with malignant melanoma involving the outline technique. A consent form for all patients was taken. The only criteria for inclusion in this study was the Berslow thickness of the tumor which had to be over 2 mm. There were 18 females and 26 males, mean age of 57 years. The primary tumor site varied: upper limbs 14, lower limbs 10, trunk 18, and head and neck 2.

RESULTS: Excision of one to 3 sentinel nodes (mean 1.4) was performed. The number of sentinel nodes was removed: one in 24 patients, 2 in 12, 3 in 6, and 4 in 2 patients. In 8/44 patients metastatic disease was detected in the sentinel node. Three patients had therapeutic lymph node dissection. There was no major complication. Four patients with one positive node each (evidence of micrometastases) have gone for lymph node dissection; one of them had one further positive node.

CONCLUSION: Sentinel lymph node biopsy is increasingly used to stage melanoma in order to avoid lymph node dissection in patients who clinically have no lymph node involvement. Sentinel lymph node biopsy is a valuable technique for melanoma staging; however, impact on overall survival requires longer follow-up.