Sentinel lymph node mapping and selective lymphadenectomy: the standard of care for melanoma.

Selective sentinel lymphadenectomy (SSL) should be considered a standard of care approach for staging patients with primary invasive melanoma 1 mm or greater. It is essential that multidisciplinary teams should master the techniques of preoperative lymphoscintigraphy, intraoperative lymphatic mapping, and pathologic evaluation of the sentinel lymph nodes (SLNs). An SLN may be blue, hot, or any lymph node (LN) greater than 10% of the in-vivo count of the hottest LN. An enlarged or indurated LN should be removed because it may contain metastatic cancer cells that block blue dye or radiotracer entry. Frozen sections are not recommended. Surgeons who use isosulfan blue dye should be cognizant of treatment for a potentially fatal reaction. Prophylactic LN dissection should not be performed if a SSL can be performed as a staging procedure. A complete LN dissection is performed if the SLN is positive. It is important to follow the clinical outcome of patients undergoing SSL, thus its role can be further defined.