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Sentinel lymph node biopsy for melanoma: an important risk-stratification tool

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This test should be routinely considered for patients with intermediate thickness melanoma

Most patients with a new diagnosis of melanoma present with localised disease without clinical evidence of metastasis and are cured by surgical resection. However, a small proportion will harbour occult metastatic disease in the regional lymph nodes. The presence of nodal involvement is the most significant prognostic factor in patients without clinical evidence of distant metastasis.1 The most sensitive test to identify these patients at presentation is sentinel lymph node biopsy (SLNB).1,2 The sentinel lymph node is the first draining lymph node from the area of skin where the primary tumour arose. The technique was first described over 20 years ago.3 Careful histological examination of the sentinel lymph node by a combination of routine histological and immunohistochemistry tests can accurately identify small-volume metastatic disease.

On the basis of initial reports, SLNB has rapidly become the standard of care in major melanoma centres around the world for patients with melanoma greater than 1 mm in thickness (stage T2 and above; Box 1) and incorporated into the American Joint Committee on Cancer staging system.1