Lymphatic mapping and sentinel lymphadenectomy for melanoma.

Intraoperative lymphatic mapping and sentinel lymphadenectomy (SLND) for patients with clinical Stage I melanoma was developed to determine the tumor status of the regional lymphatic basin without elective regional node dissection. Only individuals with histologically confirmed sentinel node (SN) metastases undergo complete regional node dissection, sparing those with tumor-free SN the morbidity of this procedure. Studies worldwide have confirmed the validity of the SN concept and the accuracy of SLND as a staging procedure. The incidence of false-negative SN and the rate of recurrence in the regional node basin have been low. Routine preoperative lymphoscintigraphy and refinements in surgical technique have improved the accuracy of SLND for melanoma, making it the nodal staging procedure of choice when undertaken by an experienced nuclear medicine physician, surgical oncologist and pathologist. Ongoing studies are investigating the impact of SLND on survival as well as the prognostic significance of micrometastasis detected by histopathologic and molecular techniques.