Current status of intraoperative lymphatic mapping and sentinel lymphadenectomy for melanoma: is it standard of care?

摘要: Intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) was developed as a low morbidity technique to stage the basin without potential of lymphedema nerve injury. Current areas active discussion debate include nomenclature used, clinical significance occult metastatic disease, quality control procedure, its proper role outside highvolume melanoma centers. Results an ongoing trial will determine whether LM/SL with selective complete lymph node dissection (SCLND) confers survival benefit when compared wide excision alone. In meantime, centers undertaking should exercise caution ensure acceptable level in nuclear imaging, surgical, pathologic aspects this multidisciplinary technique. Ideally, patients be followed within confines trial. During learning curve for routinely by until can accurately consistently identified. Usually, surgeon must perform at least 30 procedures achieve accurate staging regional nodal routine lymphadenectomy. The most important prognostic factor solid neoplasms including is status nodes draining primary neoplasm. relative 5-year rates 4,570 American Joint Committee on Cancer II versus 3,341 III were 77% 50% National Database from Commission College Surgeons Society. rate adjusts observed risks dying causes other than melanoma. Until recently, only method identify metastasis examination cross-section each using hematoxylin eosin (H E) staining. This sampled small portion total volume underestimated frequency involvement. Despite shortcomings (CLND) use rationalized therapeutic value who have stepwise progression metastases site before transit distant sites. Several randomized studies investigated elective CLND (ECLND). World Health Organization (WHO) concluded that delayed just effective immediate if patient closely followed. Mayo Clinic study showed no improvement overall or diseasefree ECLND. interim analysis Intergroup Melanoma Surgical Program difference between ECLND observation. When No competing interests declared.