The Challenge of Defining Guidelines for Sentinel Lymph Node Biopsy in Patients with Thin Primary Cutaneous Melanomas

Excerpt

The technique of lymphatic mapping and sentinel lymph node (SLN) biopsy was pioneered by Dr. Donald Morton of the John Wayne Cancer Institute as a minimally invasive surgical staging technique to identify patients with cutaneous melanoma who harbor occult regional node disease (i.e., microscopic nodal metastasis) and who may therefore benefit from lymphadenectomy.1 Based on the simple concept that afferent lymphatic vessels originating from the site of primary melanomas drain to specific regional lymph nodes—the SLNs—and that the histological status of these nodes reflects the status of the remainder of the regional node basin, this approach has revolutionized the management of “at-risk” patients with cutaneous melanoma during the past two decades. It allows detection of nodal disease below the discovery threshold of any available nonpathological techniques, including contemporary imaging modalities. The independent prognostic significance of SLN status has been well established in numerous studies, and accumulating evidence provides strong support for early identification and treatment of patients with melanoma metastatic to a SLN.2,3 The improved staging afforded by SLN biopsy also has been beneficial for stratifying patients eligible for clinical trials.4 SLN biopsy is currently recommended in the management guidelines for clinically localized primary cutaneous melanoma in the United States (issued by the National Comprehensive Cancer Network [NCCN])5 and in management guidelines currently used in many other countries around the world. …