Lymphatic mapping in the management of the patient with cutaneous melanoma
The surgical management of the patient with cutaneous melanoma has been revolutionized by the introduction of lymphatic mapping with sentinel lymph node biopsy. This relatively new technique allows the surgeon to identify and remove the first draining lymph node from a primary melanoma so that it can be evaluated for the presence of metastatic disease. If the node contains metastatic melanoma, a regional lymph node dissection is performed. Patients with negative sentinel lymph nodes undergo no more than a lymph node biopsy. The technique of sentinel lymph node mapping allows the surgeon to select for regional lymphadenectomy those patients who are most likely to benefit from the procedure. In addition, it allows accurate staging so that patients with negative lymph nodes can be reassured, while those with positive lymph nodes can be offered adjuvant immunotherapy.