Increasing the Efficacy of SLNB in Cases of Malignant Melanoma Located in Close Proximity to the Lymphatic Basin

Background. Being predictive of the entire nodal bed, sentinel lymph node biopsy (SLNB) is invaluable in the surgical management of melanoma. Although the concept is simple, sentinel lymph node (SLN) identification and removal can be technically challenging. Methods. A total of 102 consecutive patients have undergone SLNB in the Division of Plastic and Reconstructive Surgery of Soroka University Medical Center from 2009 to 2012. Patients have undergone SLNB using a radioactive tracer and blue stain in order to identify the SLN. Although SLNB usually precedes the wide excision of melanoma, primary lesions in close proximity ( 10？cm) to the lymph basin require wide excision before beginning the SLN quest. Results. All pathology reports confirmed the excision of lymph nodes. Conclusions. When treating MM in close proximity to the lymph basin, changing the sequence of the SLNB procedure seems to increase the efficacy of the method. 1. Introduction Malignant melanoma (MM) accounts for only 4% of all malignant neoplasms, but it is responsible for more than 77% of skin cancer deaths [1]. However, despite the fact that the MM incidence has been steadily rising, there has been a decrease in melanoma death rates for patients younger than 65 years in the United States, a finding that likely reflects early detection and improved treatment [2]. According to the American Joint Committee on Cancer (AJCC) (2009), metastasis to regional lymph nodes is the most important prognostic factor in patients with early-stage MM [3]. Sentinel lymph node biopsy (SLNB) for patients with primary cutaneous melanomas was first introduced in the early 1990s [4]. Since then, SLNB has been established as a reliable indicator of the presence of micrometastases in the nodal basin and an accurate prognostic factor in primary melanoma [5]. The concept of the SLNB is based on the principle that all lymphatic fluid from specific tissues is drained to lymph nodes, and as such the first (sentinel) lymph node filtering a specific site can be removed and evaluated for metastasis of malignant cells. Accurate identification of patients with node-negative (stage I or II) or node-positive (stage III) disease improves staging and may facilitate more accurate regional disease control and decision making of treatment with adjuvant therapy and entry to clinical trials [6]. For that reason, surgeons are trying to improve SLNB techniques in order to decrease false-positive rates and permit more specific identification of SLNs [7]. The aim of this study is to reveal certain technical aspects of SLNB