title: Lack of standards for the detection of melanoma in sentinel lymph nodes: a survey and recommendations.
abstract: BACKGROUND
  Detection of microscopic melanoma metastases in sentinel lymph nodes drives clinical care; patients without metastases are observed, and patients with metastases are offered completion lymphadenectomy and adjuvant therapy.
  
  
  OBJECTIVE
  We sought to determine common elements in currently used analytic platforms for sentinel lymph nodes in melanoma patients.
  
  
  METHODS
  An electronic survey was distributed to 83 cancer centers in North America.
  
  
  RESULTS
  Seventeen responses (20%) were received. The number of sentinel lymph node mapping procedures for melanoma ranged from less than 11 to more than 100 patients per year, with 72% of institutions mapping more than 50 melanoma patients a year. Uniform practices included (1) processing all of the lymph node tissue rather than submitting representative sections and (2) use of immunohistochemical stains if no tumor was identified on the hematoxylin-eosin-stained sections. Significant variability existed regarding the method of sectioning lymph nodes at grossing and in the histology laboratory; most bisected nodes longitudinally (94%) and performed deeper levels into the block (67%), but these were not uniform practices. S-100 was the most commonly used immunohistochemical stain (78%), followed by Melan-A (56%), MART-1 (50%), HMB-45 (44%), tyrosinase (33%), MiTF (11%), and pan-melanoma (6%).
  
  
  CONCLUSIONS
  There is a need for a standardized platform for detecting melanoma in sentinel lymph nodes. Current practices by a majority of laboratories and findings in the reported literature support the following: histologic evaluation of all lymph node tissue, use of immunohistochemical stains, bisecting lymph nodes longitudinally, and performing deeper levels into the tissue block.
authors.affiliation: From the Department of Pathology, Massachusetts General Hospital, Boston.
authors.forename: John
authors.initials: J
authors.lastname: Dekker
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Duncan
mesh_terms: D003625:Data Collection; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008545:Melanoma / Q000473:pathology / Q000556:secondary*; D061206:Neoplasm Micrometastasis / Q000473:pathology; D009656:North America; D021701:Sentinel Lymph Node Biopsy / Q000379:methods / Q000592:standards*; D012878:Skin Neoplasms / Q000473:pathology