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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 .
The sentinel lymph node biopsy (SLNB) is the standard of care for detecting nodal metastases in cutaneous melanoma patients and has been the most informative prognostic factor to guide subsequent treatment. However, ~85% of patients undergoing this procedure have no evidence of nodal metastasis.
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.
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 ...
Recently, the technique of sentinel lymph node biopsy has been developed to reduce the complications of lymph node surgery while allowing assessment of the involvement of nodes with tumor. [111] Biopsy of sentinel lymph nodes is a widely used procedure when treating cutaneous melanoma. [112] [113]
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.
In the US, technetium (99m Tc) tilmanocept is indicated with or without scintigraphic imaging for lymphatic mapping using a handheld gamma counter to locate lymph nodes draining a primary tumor site in people with solid tumors for which this procedure is a component of intraoperative management; and guiding sentinel lymph node biopsy using a handheld gamma counter in people with clinically ...
In the event that the melanoma spreads to other sites such as the lymph nodes, another biopsy called the Sentinel lymph node biopsy may provide more information in terms of outcomes. [21] More extensive melanomas may require wider excision (margins of 0.5 cm or more), digital amputation, lymphangiogram with lymph node dissection, or ...
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