RELIABILITY AND ACCURACY OF SENTINEL NODE BIOPSY IN CUTANEOUS MALIGNANT MELANOMA

AIMS: In cutaneous melanoma, biopsy of the first tumour-draining lymph-node (sentinel node, SLN) is became the procedure of choice in regional staging of melanoma patients. A tumour-negative SLN excludes lymphatic metastases and obviates the need for lymph-node dissection. METHODS: From January 1999 to December 2007, 300 consecutive patients with primary cutaneous malignant melanoma stage I or II (AJCC) were enrolled. The median age was 55 years old (range, 24 – 85); the Breslow thickness range was 0.15-15 mm; the most of patients were Clark levels of invasion III (43.3 %). All patients underwent regular follow-up. RESULTS: The SLN identification rate was 99.7%. The mean number of SLNs was 2.0 (range, 1-17) and only 1 node was removed in 45.4%. The SLN was positive for metastases in 57 of the 300 patients (19 %): 46 patients (15.3 %) had SLN macro metastases, 11 (3.7 %) had micro metastases. The completion lymph node was performed in all of them with the exception of eight micro metastatic patients who did not accept the procedure. The distribution of positive SLNs by primary lesion thickness was as follows: ≤ 1 mm, two positive SLNs/82 patients (2.4 %); between 1 mm and 4 mm, 38 positive SLNs/186 patients (20.4%); > 4 mm, seventeen positive SLNs/32 patients (53.1%). The patients in our study underwent follow-up visits every four months. The median follow-up was 60 months (range, 12 – 108 months). CONCLUSIONS: In patients with primary cutaneous melanoma the histological status of the SLN accurately reflects the presence or absence of metastatic disease in the relevant regional lymph node basin. Complete lymph node dissection should only be performed in patients with positive SLNs. The sentinel node mapping is a rational approach for the selection of patients who might benefit from early lymph node dissection of the affected basin