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Treatment is by excisional biopsy, wide local excision and possibly sentinel node biopsy. Localized melanoma, which has not spread beyond the skin, has a very good prognosis with low recurrence rates. Spread of disease to local lymph nodes or distant sites (typically brain, bone, skin and lung) marks a decidedly poor prognosis.
The concept of the sentinel lymph node is important because of the advent of the sentinel lymph node biopsy technique, also known as a sentinel node procedure. This technique is used in the staging of certain types of cancer to see if they have spread to any lymph nodes, since lymph node metastasis is one of the most important prognostic signs .
However, Sentinel lymph node biopsy for evaluating early, thin melanoma has not been shown to improve survival, and for this reason, should not be performed. [1] Patients with melanoma in situ, T1a melanoma or T1b melanoma ≤ 0.5mm have a low risk of cancer spreading to lymph nodes and high 5-year survival rates, so this kind of biopsy is ...
CP-GEP is a non-invasive prediction model for cutaneous melanoma patients that combines clinicopathologic (CP) variables with gene expression profiling (GEP). CP-GEP is able to identify cutaneous melanoma patients at low-risk for nodal metastasis who may forgo the sentinel lymph node biopsy (SLNB) procedure.
The prognosis of acral lentiginous melanoma is based on multiple factors including sex, age, race, Breslow depth, staging, and sentinel lymph node positivity. [7] Out of these factors, it is believed that sentinel lymph node positivity provides the strongest prediction of cancer recurrence and death.
It is advised to have a sentinel lymph node biopsy for lesions that are thicker or have high-risk characteristics. According to one study, patients who underwent an immediate lymph node dissection at presentation had a higher five-year survival rate than patients who underwent a delayed lymph node dissection.
The concept of sentinel lymph node biopsy in breast surgery is one of the major contributions of Giuliano to modern day breast cancer management. [3] He inherited the idea of sentinel node biopsy from his mentor Morton in early 1990s, who at that time was using the technique for skin melanoma management.
Neither sentinel lymph node biopsy nor other diagnostic tests should be performed to evaluate early, thin melanoma, including melanoma in situ, T1a melanoma or T1b melanoma ≤ 0.5mm. [114] People with these conditions are unlikely to have the cancer spread to their lymph nodes or anywhere else and have a 5-year survival rate of 97%. [ 114 ]