Sentinel node in malignant melanoma – The pathologist’s point of view
Overall, the benefit of accurate nodal staging obtained by SLN biopsy far outweighs the risks and has important implications for patient management. That is not to say that this test should be over-utilized. SLN biopsy is an extremely valuable tool to stratify a group of patients in which the standard prognostic factors have failed providing reliable information. Although SLN biopsy can still be considered a relatively “new” diagnostic tool, clear prognostic and therapeutic implications can be drawn when the samples are properly handle. The mRNA detection of melanoma-associated antigens (tyrosinase, MART-1, gp100, and others) remains experimental unless conclusive results on its clinical value are available. Finally, there are four major reasons to perform SLN biopsy. (1) SLN biopsy improves the accuracy of staging and provides valuable prognostic information. The “N classification” distinguishes between macroscopic and microscopic metastases. (2) SLN biopsy facilitates early therapeutic lymph node dissection for those patients with nodal metastases. (3) SLN biopsy identifies patients who are candidates for adjuvant therapy with interferon α-2b. (4) SLN biopsy identifies homogeneous patient populations for entry onto clinical trials of novel adjuvant therapy agents.
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