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(Drug information on 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.