INTRAOPERATIVE LYMPHATIC MAPPING IN EARLY-STAGE MALIGN MELANOMA

Elective lymph node dissection additional to wide excision in management of early stage malignant melanoma is controversial. Intraoperative mapping procedure has been suggested in order to identify the metastasis of the draining regional lymph nodes. Intraoperative mapping was performed to 18 patients who had stage II disease according to TNM classification, intradermal patent blue dye was injected adjacent to the primary lesion. Stained lymph nodes were examined for tumor metastasis with frozen section. All cases had en bloc lymph node dissection. Three patients had radical neck dissection, 3 had axillarly dissection, 6 had inguinal dissection and 6 had ilioinguinal dissection. Non-stained (non-sentinel) lymph was also examined for tumor metastasis. Sentinel lymph node was determined in 16 of 18 patients (88.8%). Among 27 sentinel nodes 10 had tumor metastasis (37%). In one case no tumor metastasis was seen in sentinel node but in non-sentinel nodes tumor metastasis was detected (false negative; 6.25%). There were no local or systemic complications. In conclusion, selective lymph node dissection may be performed for patients who have metastasis in sentinel nodes determined by lymphatic mapping. This technique is highly accurate and minimaly invasive which may terminate the argument for prophylactic lymph node dissection.

Keywords: Melanoma, lymphatic, mapping