caa a22 4500 475802942 CHVBK 20180406123742.0 cr unu---uuuuu 170329e20000401xx s 000 0 eng 10.1007/s002689910078 doi (NATIONALLICENCE)springer-10.1007/s002689910078 Standard and Nonstandard Applications of Sentinel Node-guided Melanoma Surgery [Elektronische Daten] [Jacob Schachter, Avishag Laish, Sergey Mekhmandarov, Meora Feinmesser, Eyal Fenig, Gabriel Tamir, Haim Gutman] Abstract.: Identification and histologic study of the sentinel node (SN) is an acceptable, yet not firmly established, guide for treating intermediate-thickness melanoma. This study widens the range of applications of this technique. We included 97 patients with intermediate-thickness melanoma lesions or lesions for which there is no standard treatment. Fifty-six underwent preoperative lymphoscintigraphy, and all underwent intraoperative lymphatic mapping (IOLM) using blue dye, followed by frozen section study and total node processing by serial sections. Elective lymph node dissection was performed in cases of metastasis to the sentinel node or technical failures with high risk. Four categories were defined: (A) intermediate-thickness lesions (mean 2.27 mm) (n= 45); (B) thin lesions (mean 1.14 mm) with risk factors of regional failure (n= 27); (C) lesion thickness close to but more than 4 mm (n= 10); and (D) lesions of undetermined thickness (n= 15). Median follow-up was 30 months (range 13-51 months). Intraoperative lymphatic mapping successfully identified the sentinel node (SN) in 93% of basins explored. Metastases were detected in 11 SNs. There were three lymph basin recurrences in patients with previously negative SNs, all salvaged by therapeutic lymph basin dissection and are NED (no evidence of disease). Two SN+ patients had systemic recurrences; one died of his disease, and the other is alive with disease. One SN− patient died NED owing to other cause. This technique spared 83% of category A patients from lymph node dissection. It allowed better staging and better decision making for treatment in categories B and D; and it prevented early regional recurrences in category C patients. Intraoperative lymphatic mapping with SN guidance is a novel, low-morbidity approach applicable and advantageous for a wide range and subgroups of melanoma patients. Société Internationale de Chirurgie, 2000 Schachter Jacob Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut Laish Avishag Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut Mekhmandarov Sergey Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut Feinmesser Meora Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut Fenig Eyal Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut Tamir Gabriel Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut Gutman Haim Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut World Journal of Surgery Springer-Verlag 24/4(2000-04-01), 491-495 0364-2313 24:4<491 2000 24 268 https://doi.org/10.1007/s002689910078 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689910078 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Schachter Jacob Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut NATIONALLICENCE 700 1- Laish Avishag Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut NATIONALLICENCE 700 1- Mekhmandarov Sergey Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut NATIONALLICENCE 700 1- Feinmesser Meora Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut NATIONALLICENCE 700 1- Fenig Eyal Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut NATIONALLICENCE 700 1- Tamir Gabriel Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut NATIONALLICENCE 700 1- Gutman Haim Melanoma and Soft Tissue Tumor Board, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel, IL aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/4(2000-04-01), 491-495 0364-2313 24:4<491 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer