Sentinel Lymph Node Biopsy in Melanoma

Controversies and Current Guidelines

Alison B Durham; Sandra L Wong

Disclosures

Future Oncol. 2014;10(3):429-42. 

In This Article

Abstract and Introduction

Abstract

Melanoma is a global health problem and the incidence of this disease is rising. While localized melanoma has an excellent prognosis, regional and distant disease is associated with much poorer outcomes. Optimal treatment for clinically localized melanoma requires surgical control of the primary site and accurate staging of the regional nodal basin with sentinel lymph node biopsy (SLNB). While further data are required to determine if SLNB is associated with a survival advantage, currently available data supports the use of SLNB for staging of appropriate patients and the procedure may offer benefits beyond staging. This article reviews current data that shapes guidelines regarding patient selection for SLNB in melanoma and highlights areas where performing this procedure remains controversial.

Introduction

The number of new melanoma cases is increasing worldwide.[1] In the USA alone, it is estimated that 76,690 new cases of invasive melanoma will be diagnosed in 2013, with 9480 deaths. The current estimated lifetime risk of developing invasive melanoma based on data from 2007–2009 is one in 35 for men and one in 54 for women.[2] Risk factors for the development of melanoma include family history of melanoma, the presence of >100 clinically typical nevi, dysplastic nevi, freckling, fair skin, blond or red hair, blue or green eyes, history of sunburn, high UV exposure and tanning bed use.[3–7]

Optimal treatment for melanoma requires knowledge of a large, continually changing body of literature that contains significant contributions from multiple specialties. In 1992, the technique of sentinel lymph node biopsy (SLNB) was introduced to the field of melanoma care and publications detailing its use continue to grow exponentially. While differences in interpretation of data occur, current practice guidelines across specialties are consistent in their recommendations regarding the utility of SLNB for the treatment of melanoma. This article reviews the literature that helps frame those guidelines, with specific focus on results from the MSLT-I, as this is currently the only randomized controlled trial comparing wide local excision (WLE) and SLNB with WLE and observation in the treatment of melanoma.

Many other areas of active research on this topic are ongoing, including investigations into improved selection criteria for patients undergoing SLNB based on features of the primary tumor, refinements in histopathologic and molecular evaluation of the sentinel node (SN), the prognostic importance of positive non-SNs and quality of life following the procedure, to name a few.[16–20] This article is intended to offer a concise review of the current literature that forms the basis for current guidelines regarding patient selection for SLNB, recognizing that the data that shapes these guidelines are in a state of constant flux.

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