Nodal staging in localized melanoma. The experience of the Brescia Melanoma Unit

Background and objectives: We report our experience with patients affected by cutaneous melanoma undergoing sentinel node (SN) biopsy. Methods: From November 1997 to October 2000 we performed 128 selective lymphadenectomies (SN biopsy) on 127 patients with cutaneous melanoma with Breslow thickness > 1 mm or regression or ulceration. Age, sex, tumour location ad histology were recorded. Results: Two hundred and thirty eight SNs were identified by lymphoscintigraphy in 167 Lymphatic stations, 236 of them were identified intraoperatively using a gamma probe and patent blue V injection. Twenty-one patients had SNs with melanoma metastases (15.8%), 12 patients in the groin, eight patients in the axilla and one patient in the neck. After therapeutic lymphadenectomy eight more lymph nodes with metastases of melanoma were found in the specimens of three patients. After a follow-up ranging from 10 to 56 months the results are that 111 patients are free of disease. Ten patients died. Three patients have visceral metastases and are alive. One patient has developed two more melanomas. One patient was lost to follow-up. Conclusions: Our data confirm the clinical reliability of the SN technique in melanoma; for optimisation of the therapeutic strategy, this technique might be considered the standard method of nodal staging in the evaluation of melanoma patients. (C) 2003 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.