Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Oct 24, 2022; 13(10): 861-865
Published online Oct 24, 2022. doi: 10.5306/wjco.v13.i10.861
Diagnostic biopsy of cutaneous melanoma, sentinel lymph node biopsy and indications for lymphadenectomy
Efstathios T Pavlidis, Theodoros E Pavlidis
Efstathios T Pavlidis, Theodoros E Pavlidis, 2nd Prodedeutic Department of Surgery, Hippocration Hospital, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54642, Greece
Author contributions: Pavlidis TE designed the research, analyzed the data and revised the letter; Pavlidis ET performed research, analyzed data and wrote the letter.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theodoros E Pavlidis, Doctor, PhD, Chief Doctor, Director, Full Professor, Surgeon, 2nd Propedeutic Department of Surgery, Hippocration Hospital, Aristotle University of Thessaloniki, School of Medicine, 49 Konstantinoupoleos, Thessaloniki 54642, Greece. pavlidth@auth.gr
Received: July 26, 2022
Peer-review started: July 26, 2022
First decision: September 5, 2022
Revised: September 5, 2022
Accepted: October 11, 2022
Article in press: October 11, 2022
Published online: October 24, 2022
Processing time: 85 Days and 15.6 Hours
Abstract

The incidence of cutaneous melanoma appears to be increasing worldwide and this is attributed to solar radiation exposure. Early diagnosis is a challenging task. Any clinically suspected lesion must be assessed by complete diagnostic excision biopsy (margins 1-2 mm); however, there are other biopsy techniques that are less commonly used. Melanomas are characterized by Breslow thickness as thin (< 1 mm), intermediate (1-4 mm) and thick (> 4 mm). This thickness determines their biological behavior, therapy, prognosis and survival. If the biopsy is positive, a wide local excision (margins 1-2 cm) is finally performed. However, metastasis to regional lymph nodes is the most accurate prognostic determinant. Therefore, sentinel lymph node biopsy (SLNB) for diagnosed melanoma plays a pivotal role in the management strategy. Complete lymph node clearance has undoubted advantages and is recommended in all cases of positive SLN biopsy. A PET-CT (positron emission tomography-computed tomography) scan is necessary for staging and follow-up after treatment. Novel targeted therapies and immunotherapies have shown improved outcomes in advanced cases.

Keywords: Surgical oncology, Malignant melanoma, Skin cancer, Cutaneous melanoma, Sentinel lymph node biopsy, Complete lymph node dissection

Core Tip: The value of excision biopsy for the initial diagnosis of melanoma in every suspected cutaneous lesion is important. In positive cases, the roles of sentinel node biopsy and subsequent complete lymph node dissection, along with adequate margin excision of the primary lesion site are evaluated to improve the prognosis. Novel biological agents and molecular factors will open new horizons for future management policy.