Results, morbidity, and quality of life of melanoma patients undergoing sentinel lymph node staging

The melanoma incidence is rising in the Netherlands. In 2011, probably more than 4000 people are diagnosed with melanoma. Optimal staging may lead to better treatment and prognosis of the patient. In this thesis, the value of the sentinel lymph node biopsy in cutaneous melanoma is described. The sentinel lymph node biopsy proved to be the strongest prognostic factor for disease free and disease specific survival along with ulceration of the primary melanoma. The procedure has a low morbidity rate. Patients who underwent sentinel lymph node biopsy had a better quality of life than a group of healthy people from the general population. When the sentinel lymph node contains metastases, additional therapeutic lymph node dissection is recommended. This additional lymph node dissection is associated with an moderately increased risk of short- and long-term complications. In particular groin dissections are associated with an increased risk of slight lymphedema of the affected limb. However, groin dissections had no adverse effect on the quality of life. Patients undergoing axillary lymph node dissection reported the most problems. Long- term results of the sentinel lymph node biopsy (median follow-up 68.4 months) showed that patients without metastases have a better disease free and disease specific survival than patients with metastases in the sentinel lymph node (10-year disease specific survival 78% versus 60%). In conclusion, this thesis shows that sentinel lymph node biopsy is valuable in the treatment of melanoma. The procedure itself has a low morbidity rate and no adverse events on the quality of life.