RESUMO
BACKGROUND: Melanoma is a malignant tumor that determines approximately 80% of deaths as skin cancer-related. The sentinel lymph node (SLN) represents the first filter of tumor cells toward systemic dissemination. The primary objective was to outline the surgical specifics of the sentinel lymph node biopsy (SLNB) technique, correlate the location of the lymph node with the radiotracer load, and identify the characteristics of older patients. METHODS: In this prospective study, 122 cases of malignant melanoma needing SLNB technique were included, between June 2019 and November 2022, resulting in 162 lymph nodes removed. RESULTS: Patients' mean age was 54.3 ± 14.4 years old, the prevalence of 70 years and older being 20.5%. The rate of positive SLN was 24.6%, with a single drainage in 68.9% of cases. The frequency of seroma was 14.8%, while reintervention 1.6%. The inguinal nodes had the highest preoperative radiotracer load (p = 0.015). Patients 70 years old or older had significantly more advanced-stage melanoma (68.0% vs. 45.4%, p = 0.044, OR = 2.56) and a higher rate of positive SLN (40.0% vs. 20.6%, p = 0.045,OR = 2.57). Melanoma of the head and neck was more common among older individuals (32.0% vs. 9.3%, p = 0.007,OR = 4.60). CONCLUSIONS: The SLNB has a low rate of surgical complications and the positivity of SLN is not related to radiotracer load. Elderly patients are at risk for head and neck melanoma, have more advanced stages, a higher SLN positivity, and a greater rate of surgical complications.
RESUMO
Background: The accuracy of the staging, along with the reproductibility of intraoperative lymph car-tography, and lymph node biopsy in patients with malignant melanoma was unanimously validated in the last decade. This technique allows the discovery of lymph node micrometastses with the help of immunohistochemical methods. The goal of the present study is to present the experience of our clinic in identification and biopsy protocol of the lymph node. Methods: A year-long retrospective analysis was running between March 2019 - December 2019 con-cerning 57 patients with cutaneous melanoma on which detection and excisional biopsy of the lymph node was performed. The procedure was performed by the double method using vital dye and a ra-dio-active tracer. Demographic information was filed, as well as data on location of primary tumors, tumor histology, and radioactivity level. Results: The mean Breslow thickness of primary skin melanomas was 2.7 mm. At least one lymph node was identified in 56 of the 57 patients included in the study. Among those, 15 (26%) had at least one metastatic node. The mean number of excised lymph nodes per patient was 1.6. Conclusions: The cartography and biopsy of lymph nodes need the involvement of a complex multi disciplinary team made of nuclear medicine, surgery, and anatomopathology specialists. This way one provides both a correct staging of the patient with melanoma and access to adjuvant innovative therapies, thus considerably improving the prognosis.
