, Volume 16, Issue 11, pp 2965-2967,
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Date: 11 Aug 2009

Nonsentinel Node Metastases in Melanoma: Do They Reflect the Biology of the Tumor, the Lymph Node or the Surgeon?

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Two decades ago, elective lymph node dissection was essentially abandoned as a surgical strategy for melanoma patients for clinically negative (cN0) regional lymph nodes, based on three key facts: (1) less than 20% of patients with cN0 intermediate-thickness melanomas have histopathologic evidence of nodal involvement (pN1), (2) an effective salvage strategy—therapeutic lymph node dissection at the time of nodal relapse—was felt to exist for pN1 patients upon nodal relapse, and (3) there was no compelling evidence that elective node dissection conveyed outcome advantages for pN1 patients (in particular, improved survival, better regional disease control or decreased surgical morbidity) of sufficient magnitude to offset the inescapable drawback that 80% or more of the patients subjected to the procedure were incurring morbidity without any expectation of oncologic benefit. Elective node dissection has now been replaced by sentinel node biopsy, and we find ourselves today in an eerily pa ...