Sentinel-lymph-node biopsy for cutaneous melanoma

A 38-year-old woman presented to her dermatologist with a 2-month history of changes in a mole on her right upper back. The mole had been present for a few years, but recently the patient had noticed episodes of itching and observed blood on her blouse. On skin examination, this pigmented lesion was 8 mm in diameter and had irregular borders and variegated color. An excisional biopsy was performed; pathological examination revealed a superficial spreading melanoma, 2.8 mm thick (i.e., in depth), with ulceration and six mitotic figures per square millimeter. Subsequent examination of the patient revealed a healing biopsy site over the right upper back. There was no clinical adenopathy and no evidence of in-transit or satellite metastases. The patient had no specific symptoms indicative of metastatic disease. A surgical oncologist was consulted, who recommended that the patient undergo wide excision of the primary tumor and sentinel-lymph-node biopsy in the same operative setting.