Management of Malignant Melanoma Using Sentinel Lymph Node Biopsy: A Case Report

ABSTRACT

The single most powerful prognostic factor in malignant melanoma is the status of the regional lymph node metastases. The surgical excision of involved node is the most effective treatment for local disease control. Surgical management of malignant melanoma has been the therapeutic value of elective lymph node dissection in the clinically node-negative individual. However, more recent prospective randomized trials have failed to demonstrate an overall survival benefit for patients undergoing prophylactic elective lymph node dissection. The histologic status of the sentinel lymph node reflects the status of the total nodal basin. Therefore the status of the regional lymph node metastases was confirmed by the sentinel lymph node biopsy in malignant melanoma without lymphedema and nerve injury in the patients undergoing elective lymph node dissection. In this case, we performed sentinel lymph node biopsy using lymphoscintigram and radioactive materials and confirmed no evidence of regional lymph node metastases. After wide excision of the primary tumor, the soft tissue defect with bone exposure on the heel was reconstructed with skin-grafted muscle free flap. There is no evidence of recurrence or distant metastases in this patient 1 year after excision.