SCHILDWACHTKLIERONDERZOEK OM MELANOOMPATIENTEN TE SELECTEREN VOOR REGIONALE LYMFKLIERDISSECTIE

Objective. To describe a novel approach to identify the sentinel lymph node in patients with stage I melanoma combining intradermal patent blue-V injection and gamma probe assisted surgery. Design. Descriptive study. Method. Twenty-four patients with a previously resected cutaneous melanoma, clinically staged I (Breslow thickness 0.67-6.8 mm) underwent surgery for sentinel node biopsy. Prior to surgery, lymphoscintigraphy was performed to evaluate the pathways of lymphatic drainage from the site of the previously resected melanoma. A handheld gammaprobe was used to localise the sentinel node and to define the exact site of incision. At the same time patent blue-V dye (0.1-0.2 ml) was injected intracutaneously to visualise the afferent lymphatic ducts and sentinel nodes. Results. Combining the use of the gamma probe and vital dye staining, the sentinel node could easily be localised and removed for pathological examination. Five patients with micrometastases in the sentinel node underwent a standard lymph node dissection with excision of the biopsy site. In only two of them was the lymphadenectomy specimen positive for micrometastases in other lymph nodes. Conclusion. The method described facilitates the sentinal node biopsy by combining vital dye mapping with gamma probe assisted surgery. It offers the possibility to select a subset of patients who are likely to benefit from a lymph node dissection.