[Sentinel lymph node biopsy in malignant melanoma--an update].
Ten years after the introduction of the sentinel lymph node biopsy technique in the management of malignant melanoma, it is time to take stock. The complex method has proved itself sufficiently sensitive, although a certain percentage of false-negative histological results have to be taken into account. Presently, it is still a point at issue whether sentinel lymph node biopsy should be regarded as the standard of care in high-risk patients. Three prospective multicentre trials have failed to demonstrate a survival benefit resulting from elective lymph node dissection. In contrast, a retrospective multicentre study has recently shown that patients with node metastases diagnosed by the sentinel procedure benefit from early excision of their nodal disease in terms of overall survival, as compared to patients with delayed dissection of palpable nodes. Studies worldwide have established the pathologic status of the sentinel lymph node biopsy as the most important prognostic factor for recurrence and survival after the excision of primary melanoma. As with any invasive staging procedure, sentinel lymph node biopsy should have demonstrated therapeutic consequences. Unfortunately, an unequivocally acknowledged adjuvant therapy is lacking. Moreover, the impact of complete lymph node dissection after positive sentinel biopsy on survival or local disease control has not yet been clarified.
Kretschmer
Lutz
L
Abteilung Dermatologie und Venerologie, Georg-August-Universität Göttingen, Germany. lkre@med.uni-goettingen.de
Bertsch
Hans Peter
HP
Meller
Johannes
J
D002986:Clinical Trials as Topic; D005188:False Negative Reactions; D006801:Humans; D007258:Informed Consent; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008545:Melanoma / Q000401:mortality / Q000601:surgery; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D012878:Skin Neoplasms / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D013997:Time Factors; D014944:World Health Organization