Sentinel lymph node examination in patients with clinically localized cutaneous melanoma after removal of the primary tumor

Purpose. To confirm the feasibility and necessity of sentinel lymph node (SLN) examination in patients with clinically localized cutaneous melanoma after removal of the primary tumor.
Materials and methods. The study involved 43 patients with clinically localized cutaneous melanoma who had undergone sparing or wide-local excision treatment at place of residence. SLN examination was performed using the domestic radiopharmaceutical 99mTc-Technephit and domestic specialized gamma-detector «radical».
Results. In all 43 patients, sentinel lymph nodes were identified and examined with biopsy. Subclinical SLN metastases were detected in 10 patients (23.3%), i.e. practically in every fourth patient, and all of them underwent radical lymphadenectomy. In three of these patients (30%), metastases to other lymph nodes were found. The detection rate of SLN metastases increased with level of invasion: Clark level ≤II – 0.0%, III–IV – 21.4%, V – 66.7%; Breslow’s thickness ≤1 mm – 0.0%, 1–2 mm – 12.5%, 2–4 mm – 15.8%, ˃4 mm – 66.7%. The detection rate of SLN metastases was twice as high in patients with ulcerous tumors (31.2 versus 15.0% without ulceration). It was also higher in slight lymphoid infiltration or in its absence compared to moderate and marked lymphoid infiltration: 29.4% versus 18.8%, respectively. During the follow-up period after SLN biopsy, no regional recurrence was noted.
Conclusion. It is feasible and necessary to examine SLN in patients with previously removed cutaneous melanoma. SLN examination helps prevent a regional recurrence in every fourth patient.

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