Should Sentinel Lymph Node Biopsy Be Performed in Malignant Melanoma (Skin Cancer)?

Sentinel biopsy detects nodal spread in malignant melanoma, preventing unnecessary removal of all lymph nodes.

Melanoma can have serious consequences. It develops in pigment-producing melanocytes anywhere on the skin, including beneath nails or soles. Cancer may arise in congenital or later moles. Childhood sunburn is considered the primary cause; family history also increases risk, and diagnosed patients risk a second melanoma.

Changes in mole shape or color require complete surgical removal for pathology, called biopsy. If tumor is found, its depth from surface to base is measured in mm and graded.

After diagnosis, melanoma treatment varies according to tumor depth, thickness in mm, any ulceration, regional lymph node spread and metastases to other organs. Surgery widely removes the area containing the tumor. Nodes in the affected region should also be sampled to investigate spread. If involvement is detected, all lymph nodes in that region must be removed surgically.

Nodes are small immune structures connected to vessels carrying clear lymph rather than blood. Nodal spread increases the likelihood of bloodstream dissemination. For sentinel biopsy, blue dye is injected into skin at the tumor or biopsy site, coloring lymph pathways. Highly radioactive nodes are removed during surgery and examined. If spread is found, all regional nodes are removed; otherwise they are left, avoiding unnecessary dissection.

Nodes play important roles in cancer spread. Biopsy determines melanoma distribution and stage for early diagnosis and treatment, making sentinel biopsy increasingly necessary as in many cancers.

According to the Journal of Clinical Oncology, multicenter research examined predictors of sentinel spread. Retrospective data between 1994-2012 involved melanoma depth of 1mm or less in 1250 biopsied patients. Among 1250, 65 had sentinel spread. Positive and negative groups differed significantly in Breslow thickness of at least 0.75mm, Clark level at least IV, ulceration and regression. Breslow is pathological thickness measured in micrometers; Clark indicates depth beneath skin and affected level. After average follow-up of 2.6 years, the proportion with sentinel spread was %86.2. At thickness at least 0.75mm, spread was %6.3; below 0.75mm it remained under %5.

These findings emphasize skin as well as general health. People with moles, high sun exposure or changing moles should consult doctors. Diagnosed patients must follow health rules; local tissue removal alone may be insufficient and professional assessment afterward should not be forgotten.