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Regional Nodal Staging: Clinically Node Negative

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Abstract

First developed and introduced by Dr. Donald Morton and colleagues in the early 1990s, sentinel lymph node biopsy (SLNB) is a technique to evaluate the pathologic status of regional lymph nodes (LN) in patients who present with clinically node-negative melanoma. The evidence for performing SLNB is strongest for patients diagnosed with intermediate-thickness melanomas (>1.0–4.0 mm in Breslow thickness). Additionally, SLNB may be considered for patients with higher risk thin (<0.8 mm with high-risk features, or ≥0.8–1.0 mm) and thick (>4.0 mm) melanomas. Lymphoscintigraphy with radiolabeled colloid should be performed preoperatively in order to accurately identify the regional draining nodal basin. Intradermal injection of blue dye may be additionally used intraoperatively to assist with SLN identification. For thorough pathologic evaluation, SLNs should be bivalved and serially sectioned. A combination of hematoxylin-eosin staining and immunohistochemistry (S-100, HMB-45, and MART-1) is typically utilized to identify LN metastases. SLNB specimens should be evaluated for the location of the tumor deposit within the LN (subcapsular, trabecular or intraparenchymal), presence or absence of extracapsular invasion, and size of the tumor deposit.

Keywords

Melanoma Sentinel lymph node biopsy Lymphoscintigraphy Radiolabeled colloid Isosulfan blue Lymph node sectioning Histopathologic evaluation 

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© Springer Nature Switzerland AG 2021

Authors and Affiliations

  1. 1.Department of SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of Pathology and Laboratory MedicineHospital of the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Division of Endocrine and Oncologic Surgery, Department of SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA

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