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Sentinel Lymph Node Biopsy and Complete Lymph Node Dissection for Melanoma
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.ORCID iD: 0000-0001-9107-5814
Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden;Karolinska Univ Hosp, Dept Plast Surg, Stockholm, Sweden.
Karolinska Inst, Clin Neurosci, Stockholm, Sweden;Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden.
2019 (English)In: Current Oncology Reports, ISSN 1523-3790, E-ISSN 1534-6269, Vol. 21, no 6, article id 54Article, review/survey (Refereed) Published
Abstract [en]

Purpose of Review: The main surgical treatment for invasive malignant melanoma consists of wide surgical and examination of the sentinel node and in selected cases complete lymph node dissection. The aim of this review is to present data for the optimal surgical management of patients with malignant melanoma.

Recent Findings: A surgical excision margin of 1-2cm is recommended for invasive melanoma depending on the thickness of the melanoma. Sentinel node biopsy may be considered for patients with at least T1b melanomas thickness 0.8 to 1.0mm or less than 0.8mm Breslow thickness with ulceration, classified as T1b lesion, per recent AJCC guidelines. Two randomized controlled trials have been publishedDeCOG (German Dermatologic Cooperative Oncology Group Selective Lymphadenectomy) and MSLT-2 (Multicenter Selective Lymphadenectomy Trial) comparing the complete lymph node dissection (CLND) with observation after positive sentinel node biopsy. In the MSLT-2 study, the disease control rate was improved in the immediate CLND group compared with observation but there was no difference in 3-year melanoma specific survival (86%1.3% and 86%+/- 1.2%, respectively; p=0.42). Isolated limb perfusion (ILP) or isolated limb infusion (ILI) with melphalan and actinomycin D is recommended for large and multiple in-transit metastases and satellite metastases in the extremities when local excision is considered ineffective or too extensive.

Summary: In light of new adjuvant treatment options and new indications for checkpoint inhibitors, and the lack of survival benefit after CLND, we can expect open surgery to decrease in melanoma disease.

Place, publisher, year, edition, pages
SPRINGER , 2019. Vol. 21, no 6, article id 54
Keywords [en]
Melanoma, Sentinel node, Biopsy, Complete, Lymph node, Limb perfusion, Dissection, Survival, Overall survival, Outcome, Surgery, Review, Metastasis, Therapy, Regional, Early, Surgical oncology, Surgical margin
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-383551DOI: 10.1007/s11912-019-0798-yISI: 000466532800002PubMedID: 31028497OAI: oai:DiVA.org:uu-383551DiVA, id: diva2:1316557
Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-05-20Bibliographically approved

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