Lymph Node Dissection in Patients With Melanoma and Sentinel Lymph Node Metastasis: An Updated, Evidence-Based Decision Algorithm

Actas Dermosifiliogr (Engl Ed). 2018 Jun;109(5):390-398. doi: 10.1016/j.ad.2018.02.008. Epub 2018 Apr 9.
[Article in English, Spanish]

Abstract

Recent publication of the results of clinical trials in which lymph node dissection was not associated with any survival benefit in patients with sentinel node metastasis makes it necessary to reconsider the treatment of patients with melanoma. This article provides an update on the available evidence on the diverse factors (routes of metastatic spread, predictors, adjuvant therapy, etc.) that must be considered when treating patients with sentinel node-positive melanoma. The authors propose a decision-making algorithm for use in this clinical setting. The current evidence no longer supports lymph node dissection in patients with low-risk sentinel node metastasis (sentinel node tumor load ≤1mm).

Keywords: Adjuvant therapy; Biopsia selectiva del ganglio centinela; Disección ganglionar; Lymph node dissection; Melanoma; Sentinel lymph node biopsy; Tratamiento adyuvante.

MeSH terms

  • Algorithms*
  • Clinical Decision-Making
  • Evidence-Based Medicine
  • Humans
  • Lymph Node Excision*
  • Lymphatic Metastasis
  • Melanoma / secondary*
  • Melanoma / surgery*
  • Practice Guidelines as Topic
  • Sentinel Lymph Node*
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / surgery*