Surgical regional lymph node treatment in patients with localized primary melanoma and positive sentinel lymph node biopsy: Clinical management at the National Cancer Institute of Colombia
DOI:
https://doi.org/10.35509/01239015.748Keywords:
Melanoma, sentinel lymph node, lymph node excisionAbstract
Sentinel lymph node status has been identified as the strongest prognostic factor for survival in patients with localized melanoma. There is controversy regarding surgical treatment versus observation in patients with a diagnosis of localized melanoma and tumor involvement in the sentinel lymph node. Traditionally, complete regional lymphadenectomy has been the standard management, however, this procedure has not shown benefits in melanoma-specific overall survival. Additionally, it is associated with greater morbidity and a delay in the initiation of systemic therapies with an impact on disease-free survival. A literature search was carried out in the two most important bibliographic databases as sources of clinical trials. Joint meetings were held between the functional units for breast and soft tissue tumors, clinical oncology, and pathology to establish recommendations for the therapeutic approach in relation to surgical regional lymph node treatment in patients with localized primary melanoma and positive sentinel lymph node biopsy. The decision to omit immediate regional lymphadenectomy in patients with localized cutaneous melanoma and lymph node tumor involvement in the sentinel lymph node biopsy must be individualized and made together with the patient, taking into account several aspects, including a complete pathology analysis of the surgical specimen, clinical and ultrasound follow-up of regional nodes, knowledge and awareness of the patient about their disease, early initiation of adjuvant systemic therapy, and the possibility of immediate therapeutic lymphadenectomy if regional relapse occurs.
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