Sentinel lymphadenectomy for patients with clinical stage I melanoma.

Consistent results with SLND can only be obtained through the combined efforts of the nuclear medicine physician, the surgeon, and the pathologist. These individuals must have experience with the technical details of SLND and must understand and accept the multidisciplinary nature of this technique. The reports in this issue of the Journal of Surgical Oncology prove that SLND is accurate and reproducible. Drs. Thompson and Karakousis both report a 93% rate of sentinel node identification, and Dr. Reintgen reports a rate of 96%. At JWCI, our overall rate of sentinel node identification has now reached 98%. The ultimate results of SLND as a therapeutic procedure in patients with clinical stage I cutaneous melanoma await completion of our international phase III multicenter trial ("A Clinical Study of Wide Excision Alone Versus Wide Excision with Intraoperative Lymphatic Mapping and Selective Lymph Node Dissection in the Treatment of Patients with Cutaneous Invasive Melanoma"; D.L. Morton, Principal Investigator), which is now in its third year of accrual. At the present time, we believe that lymphatic mapping and selective (sentinel) lymph node dissection is an investigational procedure whose therapeutic utility is unproven. Until clinical trials are completed and there is technique standardization among various centers, this procedure should not be used as routine therapy in a community hospital outside the setting of a clinical trial. Although intraoperative lymphatic mapping and SLND may provide prognostic information, if its therapeutic utility is not demonstrated by current multicenter clinical trials, it is likely to be replaced by molecular RT-PCR techniques that directly measure tumor burden in the blood [21].