title: Reliability and cost-effectiveness of sentinel lymph node excision under local anaesthesia versus general anaesthesia for malignant melanoma: a retrospective analysis in 300 patients with malignant melanoma AJCC Stages I and II.
abstract: BACKGROUND
  Sentinel lymph node excision (SLNE) for the detection of regional nodal metastases and staging of malignant melanoma has resulted in some controversies in international discussions, as it is a cost-intensive surgical intervention with potentially significant morbidity.
  
  
  OBJECTIVE
  The present retrospective study seeks to clarify the effectiveness and reliability of SLNE performed under tumescent local anaesthesia (TLA) and whether SLNE performed under TLA can reduce costs and morbidity. Therefore, our study is a comparison of SLNE performed under TLA and general anaesthesia (GA).
  
  
  METHODS
  We retrospectively analysed data from 300 patients with primary malignant melanoma with a Breslow index of ≥1.0 mm.
  
  
  RESULTS
  Altogether, 211 (70.3%) patients underwent SLNE under TLA and 89 (29.7%) patients underwent SLNE under GA. A total of 637 sentinel lymph nodes (SLN) were removed. In the TLA group 1.98 SLN/patient and in the GA group 2.46 SLN/patient were removed (median value). Seventy patients (23.3%) had a positive SLN. No major complications occurred. The costs for SLNE were significantly less for the SLNE in a procedures room performed under TLA (mean € 30.64) compared with SLNE in an operating room under GA (mean € 326.14, P<0.0001).
  
  
  CONCLUSIONS
  In conclusion, SLNE performed under TLA is safe, reliable, and cost-efficient and could become the new gold standard in sentinel lymph node diagnostic procedures.
authors.affiliation: Department of Dermatology, Venerology and Allergology, University of Essen-Duisburg, Essen, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Stoffels
authors.forename: J
authors.initials: J
authors.lastname: Dissemond
authors.forename: A
authors.initials: A
authors.lastname: Körber
authors.forename: U
authors.initials: U
authors.lastname: Hillen
authors.forename: T
authors.initials: T
authors.lastname: Poeppel
authors.forename: D
authors.initials: D
authors.lastname: Schadendorf
authors.forename: J
authors.initials: J
authors.lastname: Klode
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects / Q000191:economics*; D000772:Anesthesia, Local / Q000009:adverse effects / Q000191:economics*; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000191:economics* / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology*; D055815:Young Adult