title: Management of the difficult sentinel lymph node in patients with primary cutaneous melanoma.
abstract: Sentinel lymph nodes (SLN) are examined for occult melanoma metastases for accurate staging to dictate optimal therapy. The aim of this case series is to discuss clinical challenges in SLN biopsy. Ten challenging cases were identified from over 700 melanoma patients with SLN biopsy for primary cutaneous melanoma at the Yale Cancer Center Melanoma Unit. These cases were complicated by issues of (1) visualization of SLN, (2) concurrent and topographically close melanomas, (3) aberrant lymphatic drainage outside standard basins, (4) altered lymphatic drainage secondary to surgery, and (5) access to SLN. This case series identifies complex clinical scenarios encountered with SLN biopsy that should be familiar to a surgeon involved in the surgical care of melanoma patients.
authors.affiliation: Section of Plastic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06520-8041, USA.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Silverio
authors.forename: Matthew C
authors.initials: MC
authors.lastname: McRae
authors.forename: Stephan
authors.initials: S
authors.lastname: Ariyan
authors.forename: Deepak
authors.initials: D
authors.lastname: Narayan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging / Q000379:methods; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery