Ann Dermatol.  2010 Feb;22(1):26-34. 10.5021/ad.2010.22.1.26.

The Feasibility of Sentinel Lymph Node Biopsy with a Multidisciplinary Cooperative Team Approach for the Management of Koreans with Cutaneous Malignant Melanoma

• Lee SJ
• Lim HJ
• Kim HY
• Song CH
• Kim BS
• Lee WJ
• Kim DW
• Jung JH
• Park HY
• Kim SG
• Yoon GS
• Lee JT

• KMID: 2172033
• DOI: http://doi.org/10.5021/ad.2010.22.1.26

Abstract

BACKGROUND
The regional lymph nodal status is the most powerful independent predictor of survival for patients with clinical N0 primary cutaneous malignant melanoma.
OBJECTIVE
We wanted to evaluate the feasibility and morbidity of the sentinel lymph node biopsy (SLNB) staging using a multidisciplinary team approach, in cooperation with other surgical departments, at a university hospital setting.
METHODS
Twenty two patients with cutaneous melanoma and who were treated at Kyungpook National University Hospital were included in this study. They all received SLNB, which was done by the Departments of Dermatology and General Surgery. We evaluated the feasibility and side effects of SLNB. RESULTS: Pathologically-positive sentinel nodes were found in 7 of the 22 cases (31.8%) and all 7 patients were consequently upstaged. The whole process involved in SLNB was well tolerated by nearly all the patients, with only mild and transient complications being observed.
CONCLUSION
We suggest that in a Korean setting, utilizing SLNB with a multi-disciplinary team approach is a technically feasible procedure that is able to detect occult nodal metastasis with low morbidity rates in patients with cutaneous malignant melanoma.

Keyword

Malignant melanoma; Multidisciplinary approach; Sentinel lymph node; Sentinel lymph node biopsy

MeSH Terms

Dermatology
Humans
Melanoma
Neoplasm Metastasis
Nitriles
Pyrethrins
Sentinel Lymph Node Biopsy
Nitriles
Pyrethrins

Figure

• 

  Fig. 1 (A) The lymphoscintigram obtained from a patient who recently underwent surgery for cutaneous melanoma on the left sole: Lymph flows toward a single sentinel node in the left groin area (circle). (B) External γ-probe counting: approximation of the location of the SLN(s). (C) Incision (2~4 cm) on the skin & subcutis of the axilla. (D) Surgical dissection is guided by a hand-held γ detection probe and/or combined with blue dye in the axilla. (E) Harvesting SLN(s) & measuring their radioactivity. (F) Confirmation of no more significant radioactivity except the SLN(s). The excised SLN showed high radioactivity (inset).

• 

  Fig. 2 Histopathological examination of the sentinel lymph node biopsy specimen showing a negative result in case 2 (A: H&E, ×100, B: HMB45, ×100, C: S-100, ×100) and micrometastasis (arrowhead) in case 4 (D: H&E, ×100, E: HMB45, ×100, F: S-100, ×100).

• 

  Fig. 3 The algorithm of the procedure and the result of SLNB in 22 melanoma patients at our hospital.

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