Our Summary

This research paper discusses the role of sentinel node biopsy (SNB) and early lymph node removal in treating stage III melanoma, a type of skin cancer, in the context of new supplementary treatment options.

The authors point out that fully removing lymph nodes when a melanoma-positive sentinel node (the first node to which cancer cells are likely to spread from a primary tumor) is detected significantly reduces the risk of the cancer spreading to other nodes in the region. However, neither SNB nor full lymph node removal have been shown to improve survival rates.

With the advent of new supplementary treatment strategies for stage III melanoma, SNB has become even more crucial in determining the stage of the disease. Detecting early spread of melanoma cells into the sentinel node and measuring the amount of tumor present are key for planning further treatment.

The paper concludes that accurately assessing the state of regional lymph nodes using SNB is increasingly important given the effectiveness of new supplementary treatments for microscopic nodal disease. Whether or not to remove all lymph nodes in patients with a positive sentinel node should be decided on a case-by-case basis. If surgery is not chosen, long-term, close monitoring at specialized centers, including ultrasound checks, is necessary.

FAQs

  1. What is the role of sentinel node biopsy (SNB) in treating stage III melanoma?
  2. Does full lymph node removal improve survival rates for patients with stage III melanoma?
  3. How does the detection of early spread of melanoma cells into the sentinel node influence further treatment planning?

Doctor’s Tip

A helpful tip a doctor might give a patient about sentinel lymph node biopsy is to understand that this procedure is important for accurately staging the cancer and determining the best treatment plan. It can help in deciding whether further lymph node removal is necessary and can guide ongoing monitoring and treatment decisions. It is important to discuss the results of the biopsy with your healthcare team to fully understand your diagnosis and treatment options.

Suitable For

Patients with stage III melanoma, particularly those with a positive sentinel node, are typically recommended to undergo sentinel lymph node biopsy. This procedure helps determine the extent of the disease in the regional lymph nodes, which is crucial for planning further treatment and monitoring. Patients with early spread of melanoma cells into the sentinel node may benefit from early lymph node removal to reduce the risk of further spread. Ultimately, the decision to undergo SNB and subsequent lymph node removal should be made on an individual basis in consultation with a healthcare provider.

Timeline

Timeline of patient experiences before and after sentinel lymph node biopsy:

Before SNB:

  1. Patient is diagnosed with melanoma.
  2. Patient undergoes imaging tests to determine the extent of the disease.
  3. Patient undergoes a biopsy of the primary tumor to confirm diagnosis.
  4. Patient discusses treatment options with healthcare provider, including the possibility of SNB.
  5. Patient undergoes pre-operative preparations for surgery.

During SNB:

  1. Patient receives anesthesia.
  2. Surgeon injects a radioactive tracer and/or blue dye near the primary tumor to identify the sentinel node.
  3. Surgeon removes the sentinel node for examination.
  4. The removed node is sent to a pathology lab for analysis.

After SNB:

  1. Patient recovers from surgery.
  2. Pathology report confirms whether cancer cells are present in the sentinel node.
  3. Depending on the results, further treatment options are discussed, such as full lymph node removal or supplementary treatments.
  4. Patient may undergo additional imaging tests to monitor for cancer recurrence.
  5. Patient undergoes long-term follow-up care to monitor for any signs of cancer recurrence or spread.

What to Ask Your Doctor

  1. What is the purpose of a sentinel lymph node biopsy in my case?

  2. How is a sentinel lymph node biopsy performed?

  3. What are the potential risks and complications associated with a sentinel lymph node biopsy?

  4. How will the results of the biopsy impact my treatment plan?

  5. Will the biopsy results determine if additional lymph nodes need to be removed?

  6. What are the long-term implications of having a sentinel lymph node biopsy?

  7. Are there alternative methods for assessing lymph node involvement in my case?

  8. How will the results of the biopsy affect my prognosis and chances of recurrence?

  9. What is the role of sentinel lymph node biopsy in conjunction with new supplementary treatment options for melanoma?

  10. How often should I undergo follow-up monitoring after a sentinel lymph node biopsy?

Reference

Authors: Ulmer A, Kofler L. Journal: Hautarzt. 2019 Nov;70(11):864-869. doi: 10.1007/s00105-019-04491-4. PMID: 31605168