13- 15, 24Įarlier data from the MSLT-I trial demonstrated the prognostic significance of the sentinel node. The rationale for this practice is based on important data from the Multicenter Selective Lymphadenectomy Trials (MSLT)-I and II. These probabilities can be used to determine the risks and benefits of the SLNB when assessing the utility of this prognostic procedure for an individual patient. Finally, for lesions with a Breslow depth greater than 1 mm (T2a or greater), the probability is greater 10% and will vary based on additional adverse features. For lesions with a Breslow thickness less than 0.8 mm with ulceration or 0.8–1 mm with or without ulceration (T1b), the probability is 5–10%. 7–10 For lesions with a Breslow depth less than 0.8 mm without adverse features (T1a), the probability of positive SLNB is less than 5%. However, a number of additional prognostic factors have been identified and are commonly reported in pathology reports such as tumor cell mitotic rate. 6 The 8th edition of the American Joint Committee on Cancer (AJCC) T staging classification is predominantly based on Breslow thickness and the presence or absence of ulceration. The probability of a positive SLN is related to the tumor (T) stage of the primary lesion and associated adverse factors. This procedure involves intradermal injection of blue dye or radioisotope in the skin surrounding the primary lesion in order to localize, resect, and analyze the draining node(s) for the presence of subclinical metastases. The goal of the SLNB is to accurately stage and assess the draining nodal basin in patients with no clinical evidence of regional disease. The WLE procedure involves excision of the lesion with 1–2-cm margins and resection of the subcutaneous tissues to the level of the deep fascia. Wide local excision (WLE) with sentinel lymph node biopsy (SLNB) remains the cornerstone for treatment of melanoma lesions with Breslow thickness greater than 0.8 mm and clinically negative nodes (stage I/II disease). 2 Finally, survival was historically poor in patients with distant metastatic sites such as the lung, brain, or bone (stage IV), but recent advances in targeted therapy and immune checkpoint blockade have reshaped the treatment landscape. Prognosis varies widely among patients with locoregional disease (stage III) and primarily depends on tumor burden in draining lymph nodes and resectability of the primary lesion. In the setting of localized disease with a primary greater than 1 mm in thickness, 5-year survival depends on Breslow depth, ulceration, and mitotic rate but can approach 90%. For patients with lesions less than 1 mm in thickness and no nodal involvement, 5-year survival is excellent. 1 Early identification of suspicious skin lesions is critical. Invasive cutaneous melanoma is estimated to be the sixth most common cancer in the United States, accounting for approximately 84,000 new cases and 8,200 deaths in 2018. Melanoma sentinel lymph node biopsy lymphangiography surgical oncology. We also highlight recent advances in postoperative treatment of those with clinically occult regional disease. The surgical management of intermediate-thickness melanoma and rationale for treatment are reviewed. In this paper with accompanying animation and video, a 40-year-old otherwise healthy patient presents with a new melanoma on his back diagnosed via biopsy. WLE is accompanied by lymphatic mapping in order to localize, resect, and analyze the sentinel node(s) for the presence of lymph node metastases. This procedure involves resection of the melanoma with circumferential margins including all the subcutaneous tissue to the level of the deep fascia. Wide local excision (WLE) with sentinel lymph node biopsy (SLNB) remains the cornerstone for treatment of patients with intermediate-thickness and thick melanoma lesions with clinically negative nodes.
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