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Giornale Italiano di Dermatologia e Venereologia 2000 February;135(1):21-7


language: Italian

Preliminary personal data about sentinel node dissection: a new standard in the diagnostic and therapeutic approach to melanoma.

Crudeli F., Bagnoni G., Fedi E., Ceccarini M., Marchetti G. *, Morini V. **

ASL 6 - Regione Toscana - Ospedale di Livorno UO Dermatologia (Direttore: Prof. F. Crudeli) * UO Anatomia Patologica ** UO Medicina Nucleare


Elective lymphnode dissection (ELND) for treatment of melanoma is controversial. Sentinel node dissection involves removing the primary lymphnode in a basin that drains a particular cutaneous lesion. Theoretically this node (Sentinel Lymph Node: SLN) would collect regional metastasis first; therefore, if this SN is negative, the chances are low that melanoma would have spread systematically or to other nodes within this basin. Removing one node would decrease the morbility associated with radical lymphnode dissection. The strategy of SLN biopsy should satisfy both the opponents and advocates of ELND, because it allows entrance to adjuvant trials for patients early in their clinical course, rather than after grossly palpable disease has developed and it also removes a possible source of metastatic disease, if in fact microscopic disease is present in their basin. Objective of this work is to present ten cases of intermediate thickness melanoma treated with selective lymph node dissection, and to review the techniques of selective lymphadenectomy and lymphoscintigraphy. The sentinel node(s) have been successfully identified in all our patients, and metastasis detected in 4/17 patients (in one case exclusively by immunohistochemistry. No postoperative complications have been observed. The preliminary findings in this limited series suggest that sentinel lymphnode dissection might be a procedure of low morbidity and high predictive value.

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