Recent Advances in the Care of the Patient with Malignant Melanoma

Abstract

ObjectiveThe authors review the recent advances in the surgical care, staging, and adjuvant treatment of the patient with melanoma. Summary Background DataMelanoma care has not changed significantly in the last 20 years, and the controversy of elective lymph node dissections in this disease continues to be discussed. Two advances in the care of the patient with melanoma have occurred in the last 3 years to make this an exciting time for clinicians and to offer more hope for the patients with this disease. The concept of the sentinel lymph node (SLN), defined by Morton as the first node in the lymphatic basin that drains the primary melanoma, has been documented to contain the first site of metastatic disease. This technology can be used to stage nodally the melanoma patient, identifying the subgroup of patients (stage 111) who have a 5-year survival rate less than 50%. Members of this group are candidates for effective adjuvant therapies. MethodsA review of the surgical techniques of melanoma care, including recently reported new studies of elective node dissection (ELND) and SLN biopsy in patients with melanoma was performed. In addition, the Eastern Cooperative Oncology Group (ECOG) 1684 trial, which was the basis for the Food and Drug Administration approval of adjuvant interferon-alpha2b (IFN-a-2b) is discussed. ResultsThe Intergroup Melanoma Trial has reported a survival benefit for performing ELND in patients with melanoma and tumor thickness between 1 and 2 mm or in patients that are younger than 60 years of age. With six reports in the literature that show there is an order to melanoma nodal metastases and that the SLN histology is reflective of the histology of the remainder of the nodal basin, the more conservative SLN biopsy can be performed to adequately stage nodally the patient with melanoma. Patients with nodal metastases who are rendered free of disease with surgical resection have the most to benefit from adjuvant IF-a-2b. If one considers only the lymph node-positive group of patients, the survival benefit associate with adjuvant IFN is significant (p = 0.008).

The accuracy of sentinel node mapping according to T stage in patients with gastric cancer

“…Since then, sentinel node biopsy has been used in the management of a variety of cancers in the hope that it will eliminate many unnecessary lymph node dissections, resulting in less morbidity. Today, SLN mapping is recognized as a multidisciplinary surgical approach to the management of patients with cutaneous melanoma and breast cancer [3][4][5][6], but it is also being evaluated and used in patients with gastrointestinal malignancies, especially gastric cancer [7][8][9][10][11][12]. The regional lymph node status is crucial for staging and estimating the prognosis of the individual patient with gastric cancer resected for cure [13].…”

Learning Curve for Identification of Sentinel Lymph Node Based on a Cumulative Sum Analysis in Gastric Cancer

“…This concept has been evaluated in various tumors, and the prediction of node status in melanoma and breast cancer by a sentinel node biopsy showed promising results [11,12]. Results from sentinel node mapping in gastric cancer have been various because lymphatic drainage of the stomach is much more complicated, skip metastasis is common, a standard technique for sentinel node detection has yet to be determined, and because of the learning curve [13,14,15].…”

Vital dye is enough for inguinal sentinel lymph node biopsy in melanoma patients

“…O linfonodo sentinela era considerado como identificado pelo corante vital se estivesse azul e identificado pela sonda de detecção gama se demonstrasse pelo menos 10 SLN procedure involves three phases as follows: (1) preoperative lymphoscintigraphy; (2) biopsy of the sentinel node -by means of lymphatic mapping with vital dye and intraoperative gamma probe detection (GPD); (3) histological examination of the node. 5 Lymphoscintigraphy shows the drainage basins and allows localizing SLN and its projection over the skin. It is essential for this procedure.…”