The purpose of this paper was to present our 4-year experience with sentinel node biopsy in the treatment of malignant melanoma. We will present technical details that influence the efficacy of the procedure and discuss the clinical, therapeutic and prognostic advantages of this technique. A total of 259 consecutive patients with primary skin melanoma (T2–3 N0 M0) underwent sentinel node biopsy between March 1996 and May 2000. All patients underwent previous excisional biopsy of the primary lesion and clinical and radiographic examination to exclude lymphatic or systemic macroscopic spread of the disease. Preoperative lymphoscintigraphy (99mTc-nanocoll) was routinely performed in the last 184 patients. Intraoperative detection of the sentinel node was performed by perilesional, intradermal injection of blue dye associated with a gamma probe (Neoprobe 2000) in the last 141 patients. For each anatomical site of dissection (inguinal, axillary, head and neck), detection rates with or without gamma probe were compared, focusing on the main reasons for failure. Sentinel nodes, serially sectioned, were all hematoxylin-eosin and immunohistochemically stained. All patients positive for micrometastasis underwent radical lymphadenectomy. Comparative analysis was performed between the incidence of metastasis in sentinel and non-sentinel nodes, according to the clinical stage of the disease. The overall detection rate of sentinel nodes was 96%. Relevant differences were found according to the site of dissection and the use of a gamma probe. The gamma probe makes the procedure more effective, less invasive, and less expensive. Timing and accuracy of the preoperative lymphoscintigraphy are basic steps in the procedure. The overall incidence of positive sentinel node was 14.6% with differences correlated with thickness of primary lesion (0.75–1.5 mm: 7.3%; 1.5–3 mm: 14.9%; 3–4 mm: 30.5%). Metastasis in other non- sentinel nodes was found only with primary tumor thickness exceeding 2 mm. Correlation between sentinel node metastasis and prognosis as well as adjuvant therapy will be discussed. Sentinel node biopsy is a procedure requiring a multidisciplinary approach (surgery, nuclear medicine, and pathology). A specific learning phase (>30 patients) is recommended for reliable results. An improvement in survival rates by sentinel node biopsy has not yet been demonstrated, but this more accurate N-staging procedure offers clear advantages in terms of the patient’s quality of life, prognosis, and indication for adjuvant therapy.
European Journal of Plastic Surgery – Springer Journals
Published: Dec 15, 2000
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