Surgical Management of Axillary Lymph Node Metastasis in Cutaneous Melanoma and Non-melanoma Skin Cancer
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The management of lymph node metastases in cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC), malignancy of skin appendages and some kind of soft tissue sarcomas like epitheloid and clear cell sarcomas remains a controversial topic, with no prospective studies demonstrating convincing evidence of improved survival with nodal dissection. It is, however, clear that lymph node status is an important prognostic factor in early-stage melanoma and adequate nodal evaluation is necessary for accurate staging. With the advent of lymphatic mapping with vital blue dye and radiocolloid, the performance of sentinel lymph node biopsy (SLNB) for melanoma patients has been revolutionary in decreasing the number of patients undergoing elective lymph-node dissection . As in breast cancer, SLNB has been shown to be extremely prognostic, with a negative SLNB successfully identifying patients that will have a better prognosis, and that are unlikely to have positive nodes in the remainder of the nodal basin . Although the morbidity is notably lower than in complete lymphadenectomy, SLNB still carries a morbidity rate of approximately 10% and is therefore not recommended in all melanoma patients . In 2012, the American Society of Clinical Oncology (ASCO) and the Society of Surgical Oncology (SSO) created a joint clinical practice guideline for the use of sentinel lymph node biopsy (SLNB) and completion lymph node dissection (CLND) for melanoma  (see also Chaps. 6 and 22).
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