Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Apr 10, 2016; 7(2): 174-188
Published online Apr 10, 2016. doi: 10.5306/wjco.v7.i2.174
Clinical utilities and biological characteristics of melanoma sentinel lymph nodes
Dale Han, Daniel C Thomas, Jonathan S Zager, Barbara Pockaj, Richard L White, Stanley PL Leong
Dale Han, Daniel C Thomas, Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, United States
Jonathan S Zager, Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, United States
Barbara Pockaj, Mayo Clinic, Scottsdale, AZ 85259, United States
Richard L White, Division of Surgical Oncology, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC 28204, United States
Stanley PL Leong, Center for Melanoma Research and Treatment, California Pacific Medical Center, San Francisco, CA 94107, United States
Author contributions: Han D and Thomas DC contributed equally to this manuscript; Han D, Thomas DC and Leong SPL contributed to the literature review, drafting, critical revision, and editing of the manuscript; Han D and Leong SPL contributed to the conception and final approval of the manuscript; Zager JS, Pockaj B and White RL contributed to the critical revision and editing of the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stanley PL Leong, MD, Center for Melanoma Research and Treatment, California Pacific Medical Center, 2340 Clay Street, 2nd Floor, San Francisco, CA 94107, United States. leongsx@cpmcri.org
Telephone: +1-415- 6003800 Fax: +1-415-6003865
Received: October 2, 2015
Peer-review started: October 9, 2015
First decision: November 4, 2015
Revised: January 8, 2016
Accepted: February 14, 2016
Article in press: February 16, 2016
Published online: April 10, 2016
Processing time: 188 Days and 11.4 Hours
Abstract

An estimated 73870 people will be diagnosed with melanoma in the United States in 2015, resulting in 9940 deaths. The majority of patients with cutaneous melanomas are cured with wide local excision. However, current evidence supports the use of sentinel lymph node biopsy (SLNB) given the 15%-20% of patients who harbor regional node metastasis. More importantly, the presence or absence of nodal micrometastases has been found to be the most important prognostic factor in early-stage melanoma, particularly in intermediate thickness melanoma. This review examines the development of SLNB for melanoma as a means to determine a patient’s nodal status, the efficacy of SLNB in patients with melanoma, and the biology of melanoma metastatic to sentinel lymph nodes. Prospective randomized trials have guided the development of practice guidelines for use of SLNB for melanoma and have shown the prognostic value of SLNB. Given the rapidly advancing molecular and surgical technologies, the technical aspects of diagnosis, identification, and management of regional lymph nodes in melanoma continues to evolve and to improve. Additionally, there is ongoing research examining both the role of SLNB for specific clinical scenarios and the ways to identify patients who may benefit from completion lymphadenectomy for a positive SLN. Until further data provides sufficient evidence to alter national consensus-based guidelines, SLNB with completion lymphadenectomy remains the standard of care for clinically node-negative patients found to have a positive SLN.

Keywords: Melanoma; Metastasis; Review; Biologic characteristics; Sentinel lymph node; Sentinel lymph node biopsy

Core tip: This review examines the development of sentinel lymph node biopsy for melanoma as the quintessential technique for determining a patient’s nodal status, the efficacy of sentinel lymph node biopsy in patients with melanoma, and the biology of melanoma metastatic to sentinel lymph nodes.