According to the American Joint Commission on Cancer (AJCC) 8th edition guidelines, SLN biopsy is recommended for primary melanomas with a Breslow thickness of at least 1 mm. Additionally, the National Comprehensive Cancer Network (NCCN) recommends that a SLN biopsy may be considered for melanoma patients with T1b lesions, which are 0.8–1 mm thick or less than 0.8 mm thick with ulceration. It can also be considered for T1a lesions that are less than 0.8 mm thick but have other adverse features, such as a high mitotic rate, lymphovascular invasion, or a positive deep margin. To reduce the false negative rate of melanoma SLN biopsy, we have introduced the intraoperative use of Sentinella, a gamma camera, to enhance the identification rate of SLNs beyond that of the traditional gamma hand-held probe. At the Center for Melanoma Research and Treatment at the California Pacific Medical Center, a multidisciplinary approach has been established to treat melanoma patients when the diagnosis of primary melanoma is made with a referral to our melanoma center. This comprehensive approach at the melanoma tumor board, including the efforts of pathologists, radiologists, dermatologists, surgical, medical and radiation oncologists, results in a consensus to deliver personalized and high-quality care for our melanoma patients. This multidisciplinary program for the management of melanoma can be duplicated for other types of cancer. This article consists of current knowledge to document the published methods of identification of sentinel lymph nodes. In addition, we have included new data as developed in our melanoma center as newly published materials in this article to demonstrate the utility of these methods in melanoma sentinel lymph node surgery. Informed consent has been waived by our IRB regarding the acquisition of clinical data as presented in this study.
根据美国癌症联合委员会（AJCC）第八版指南，建议对Breslow厚度至少1毫米的原发性黑色素瘤进行前哨淋巴结（SLN）活检。此外，美国国家综合癌症网络（NCCN）建议，对于T1b期病变（厚度0.8-1毫米或厚度小于0.8毫米但伴有溃疡）的黑色素瘤患者，可考虑进行SLN活检。对于厚度小于0.8毫米但具有其他不良特征（如高有丝分裂率、淋巴血管侵犯或深部切缘阳性）的T1a期病变，也可考虑进行SLN活检。为降低黑色素瘤SLN活检的假阴性率，我们引入了术中应用Sentinella伽马相机的技术，以提高SLN的识别率，超越传统手持式伽马探针的检测能力。在加州太平洋医疗中心黑色素瘤研究与治疗中心，我们建立了多学科协作模式，当原发性黑色素瘤确诊后，患者会被转诊至我们的黑色素瘤中心接受治疗。通过黑色素瘤肿瘤委员会的综合评估，包括病理学家、放射科医生、皮肤科医生、外科、内科及放射肿瘤学家的共同参与，形成共识，为黑色素瘤患者提供个性化、高质量的诊疗方案。这种多学科协作的黑色素瘤管理模式也可推广应用于其他类型癌症的治疗。本文综述了当前识别前哨淋巴结的已发表方法，并纳入了我们黑色素瘤中心最新发表的研究数据，以展示这些方法在黑色素瘤前哨淋巴结手术中的应用价值。本研究涉及的临床数据收集已获得机构审查委员会（IRB）豁免知情同意的批准。
Preoperative and Intraoperative Identification of Sentinel Lymph Nodes in Melanoma Surgery
肿瘤(癌症)患者之家