Dr. Natale Cascinelli, president of the World Health Organization
(WHO) Melanoma Program, declared intraoperative lymphatic mapping to
be the standard of care for melanoma. He made this statement during
his presentation of the abstract, An Overview on Sentinel Lymph
Node Dissection at the 9th International Congress on
Anti-Cancer Treatments in Paris.
In his abstract, Dr. Cascinelli stated, ..sentinel node biopsy
represents the key to select patients harboring clinically inapparent
metastatic nodes and the concept of selective dissection is
introduced as the clue to overcome unuseful elective nodal
dissections. Sentinel node biopsy is a reliable and safe procedure
for accurate staging of clinical stage I melanoma patients and for
adequate selection of patients to submit to nodal dissections and
adjuvant treatments. The adoption of preoperative lymphoscintigraphy
and intraoperative probe drastically increases the chance for SN
identification. The status of SN represents at multivariate analysis
a mostly important prognostic factor for overall and disease-free
survival. Sentinel node biopsy currently represents the standard of
care in the management of stage I melanoma patients and the starting
point for future policies on surgery and adjuvant treatment strategies.
More Appropriate Staging
Physicians use intraoperative lymphatic mapping to trace the
lymphatic patterns in a patient. Evaluation of the potential tumor
drainage and spread is intended for the purpose of more appropriately
staging patients. Lymphatic mapping begins with a patient being
injected with a commercially available radioactive tracing agent, eg,
filtered sulfur colloid labeled with techne-
tium-9mm, at the tumor site. The agent is intended to follow the same
lymphatic flow as the tumor would if it had metastasized or spread.
The surgeon may then track the agents path with the probe, thus
following the potential avenues of tumor spread and identifying the
sentinel lymph nodes to be tested for cancer.