Surgical treatment of >pT1b melanoma

A sentinel lymph node (SLN) is defined as the first lymph node to which cancer cells are most likely to spread from a primary tumor. Sometimes, there can be more than one SLN. Sentinel lymph node biopsy is done in combination with the re-excision. The SLN is located by scintigraphy maximal 24 hours prior to surgery.

At the department of nuclear medicine a radioactive tracer is injected in 4 depots around the scar from the diagnostic excision. Then scintigraphy is performed and the sentinel node(s) will be marked with a waterproof marker. During surgery the SLN can be found by using a special device which can detect the radioactivity. First, the SLN is removed and then re-excision is performed. In our patient the wound can be closed primary, but sometimes, especially when 2 cm re-excision margin is indicated a skin graft is necessary. Total surgery time is about one hour and can be done on outpatient basis or may require a short stay in the hospital.

Pathological findings will be discussed in the multidisciplinary tumor board 10-14 days after surgery. Depending on these findings, further treatment or follow up will be determined. Unfortunately, small metastasis were found in the sentinel node, so our patient is upstaged to pT1bN1 melanoma.