Sentinel Node Biopsy and Selective Dissection for Melanoma Nodal Metastases

Belli, Filiberto; Lenisa, Leonardo; Clemente, Claudio; Tragni, Gabrina; Mascheroni, Luigi; Gallino, Gianfrancesco; Cascinelli, Natale

doi:10.1177/030089169808400105

Cited by 17 publications

(22 citation statements)

References 19 publications

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“…Johnston et al could not find a significant difference in response rate and in survival between the Dartmouth regimen followed by IL-2/IFN-a and the Dartmouth regimen alone, though low doses of IL-2/IFN-a were administered subcutaneously in their study (24). In a prospective randomized trial conducted by Rosenberg et al sequential combination of CDDP, DTIC, and tamoxifen with IL-2/ IFN-a was not significantly superior to the chemohormonal therapy alone in response rate (44% vs 27%) as well as in median survival time (15.8 vs 10.7 months, PΩ0.052) (25).…”

Section: Significance Of Sequential Biochemotherapy Is Not Determinedmentioning

confidence: 82%

“…In effect, we are strongly convinced that lack of identification or an incomplete identification of S.N., which could be responsible for the sporadic local relapses referred to in some series (14,24), probably reflects technical difficulties due to the surgeon's learning curve. The introduction of modalities of identification of S.N.…”

Section: How To Treat Nodal Melanoma Metastases Todaymentioning

confidence: 83%

“…Recently, results of randomized trials or sequential biochemotherapy were reported (24)(25)(26). Johnston et al could not find a significant difference in response rate and in survival between the Dartmouth regimen followed by IL-2/IFN-a and the Dartmouth regimen alone, though low doses of IL-2/IFN-a were administered subcutaneously in their study (24).…”

Section: Significance Of Sequential Biochemotherapy Is Not Determinedmentioning

confidence: 95%

“…The feasibility of the procedure of intraoperative lymphatic mapping is mainly demonstrated comparing the incidence of metastases in sentinel draining nodes with that in secondary nondraining nodes. All the reported experience (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) indicates that the S.N. is the lymph node most likely to harbor metastatic melanoma.…”

Section: How To Treat Nodal Melanoma Metastases Todaymentioning

confidence: 99%

“…other than blue dye, such as lymphoscintigraphy or probeguided biopsy, should improve consistently the possibility to identify the S.N. even through a minimal surgical access (22)(23)(24)(25). As a matter of fact, the use of radiotracers for detection of the S.N.…”

Section: How To Treat Nodal Melanoma Metastases Todaymentioning

confidence: 99%

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What is the most promising strategy for the treatment of metastasizing melanoma?

Cascinelli¹,

Heerlyn

Schneeberger

et al. 2000

Experimental Dermatology

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The treatment of patients with metastasizing melanoma, still one of the most deadly diseases in modern medicine, ranks among the greatest challenges that a clinician has to face. Metastatic melanoma also is one of the most profound sources of clinical frustration, since it provides far more ultimately defeating experiences than clinical victories. At the same time, the fascinating biology of melanoma has invited the study of this neuroectodermal tumor as a model system for dissecting many of the key problems of modern oncology, ranging from molecular oncogenesis via the controls of tumor proliferation, apoptosis, invasion, metastasis, and angiogenesis to tumor immunosurveillance and tumor drug resistance. Together with the dire need to develop more effective treatment modalities for improving both life expectancy and quality of life of affected patients, this has made metastatic melanoma a favorite model Viewpoint 1Melanoma is one of the tumors that most frequently metastasizes to regional lymphnodes and to distant sites. The high degree of malignancy and the poor final outcome correlated with this disease has strongly stimulated in the past decades many studies and clinical trials to help defining the most suitable therapy in these cases. Even though in the area of treatment of nodal metastases important innovations have been introduced in the recent past, for distant metastases, no convincing solution is available at the moment. 439for the exploration of innovative strategies for tumor management. Encouragingly, many of these have already generated very promising results in animal models. However, this impressive level of research progress in conquering melanoma in the animal room contrasts rather pitifully with the actual progress made on the ward. This CONTROVERSIES feature, therefore, critically and soberly reviews the state of the art of treating metastatic melanoma today (distinguishing between nodal and distant metastases), and sharply defines unresolved or comparatively neglected key problems. In addition, this feature highlights several novel, provocative, hitherto underappreciated, yet potentially promising treatment approaches that deserve systematic exploration. Hopefully, this will offer further inspiration for the design and pursuit of innovative anti-melanoma strategies off-the-beaten-track. How to treat nodal melanoma metastases todaySurgery remains the only effective option for treating nodal metastases from cutaneous melanoma since chemotherapy and radiotherapy do not achieve the same cure in patients with nodal disease. However the indication for performing an elective lymph node dissection (ELND) or a delayed one (DLND) is contested (1-8).The supporters of ELND invoke the following arguments: 1) the significant incidence of silent

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Section: Significance Of Sequential Biochemotherapy Is Not Determinedmentioning

confidence: 82%

Section: How To Treat Nodal Melanoma Metastases Todaymentioning

confidence: 83%