Outcome of Patients With Melanoma and Histologically Negative Sentinel Lymph Nodes

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Abstract
AS WITH MANY other malignant neoplasms, melanoma metastasis may develop as a result of either lymphatic or hematogenous dissemination. The most powerful prognostic factor for patients with American Joint Committee on Cancer stage I and II melanoma is the presence or absence of metastatic melanoma in their regional lymph nodes.1 The hypothesis that some patients may harbor occult regional lymph node metastases prior to the establishment of distant metastases has served as the rationale for performing elective lymph node dissections (ELNDs). However, results of prospective randomized clinical trials designed to evaluate the efficacy of ELND have demonstrated either no survival benefit or survival benefit only to selected subgroups.2,3 In addition, the development of lymphatic mapping and sentinel lymph node biopsy has provided a less invasive method for determination of whether melanoma has spread to regional lymph nodes.4