Current management of regional lymph nodes in patients with melanoma

Abstract

The publication of recent randomized trials has prompted a significant shift in both our understanding and the management of patients with melanoma. Here, the current management of the regional lymph nodes in patients with melanoma is discussed. This review focuses on selection for sentinel lymph node biopsy, management of the positive sentinel node, management of the clinically positive node, and the controversy over the therapeutic value of early nodal intervention.

Keywords: Completion lymph node dissection (CLND); melanoma; sentinel lymph node (SLN); sentinel lymph node biopsy (SLNB); stage III melanoma.

Figure 1.. The various scenarios of metastatic progression in melanoma.

The displayed percentages are an estimation of all patients with intermediate thickness melanoma who fall into the indicated category. Estimates are based upon the long-term results of MSLT-1, which demonstrated a 19.5% recurrence rate in observed patients and 21.9% in patients undergoing SLN biopsy. In patients undergoing a SLN biopsy, a nodal metastasis incidence of approximately 20% is the sum of those detected by SLN biopsy and nodal recurrences after a false-negative SLN biopsy. Purple dots denote melanoma metastases.