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Dermatologia, Ospedale M. Bufalini, Cesena, Italia
Until three decades ago, the biological malignity of cutaneous melanoma (CM) led surgeons to adopt a particularly aggressive surgical approach, performing immediate complete regional lymph node dissection (CLND) in the presence of any CM thicker than 1.5 mm. Since the end of the Seventies, three prospective multicentre trials have failed to demonstrate a survival benefit resulting from prophylactic CLND that was so stopped, even if it was known that about 20% of patients with CM were carriers of subclinical metastases in their regional LFNs. As it is believed that precocious removal of metastases may offer a better chance to cure and prevent overt metastases, in the late Eighties, Donald Morton developed the technique of the sentinel lymph node biopsy for selecting patients with such occult nodal metastases. The goal was to offer CLND only to those at risk of nodal progression and sparing the remaining 80% the morbidity of troublesome DLND. In 2006, the results of Multicentre Selective Lymphadenectomy Trial (MSTL-I) disclosed that the SLN biopsy technique provides better control of relapses in the regional nodes, but has no therapeutic benefit versus that of nodal observation in CM patients. Since then SLN biopsy was considered the most accurate technique for staging invasive CM. The lymph node biopsy technique has only anticipated the possible lymph node recurrence of neoplastic disease with the only result of amplify the physical and psychological discomfort of the patient in a context of lack of benefits in terms of disease-free time and survival.