Starting with its earliest descriptions, melanoma has been recognized as a tumor with a predilection for metastasis to regional lymph nodes. This tendency led to initial recommendations for very aggressive early surgical management of the regional nodal basin. However, those recommendations were the source of much controversy over nearly a century, until the minimally invasive surgical technique of sentinel lymph node (SLN) biopsy was developed by Morton, Cochran and colleagues. This technique has been evaluated in a series of prospective clinical trials, which have clarified its role and the management of lymph nodes in this disease. Current controversies relating to SLN biopsy include optimal selection of patients for the procedure, the role of gene expression profiling in initial melanoma management, and the potential therapeutic effects of SLN biopsy-based management. In addition, the SLN appears to be a rich source of data relating to the host–tumor interface and the immune microenvironment, which may advance our understanding of the biology of melanoma. Finally, although the surgical technique is well developed at this point, there may be additional technical improvements that are possible as well.
自最早被描述以来，黑色素瘤就被认为是一种倾向于转移至区域淋巴结的肿瘤。这一特性最初促使人们建议对区域淋巴结池采取非常积极的早期外科处理。然而，这些建议在近一个世纪里引发了诸多争议，直到莫顿、科克伦及其同事开发出前哨淋巴结活检这一微创外科技术。该技术已通过一系列前瞻性临床试验得到评估，从而明确了其作用以及在该疾病中淋巴结的处理方式。当前关于前哨淋巴结活检的争议包括：如何优化选择适合该手术的患者、基因表达谱分析在黑色素瘤初始治疗中的作用，以及基于前哨淋巴结活检的治疗可能带来的潜在治疗效果。此外，前哨淋巴结似乎是宿主-肿瘤界面和免疫微环境相关数据的丰富来源，这可能推动我们对黑色素瘤生物学的理解。最后，尽管目前外科技术已相当成熟，但仍可能存在进一步的技术改进空间。
Selective Sentinel Node Dissection in Melanoma with Trends and Future Directions
肿瘤(癌症)患者之家