Surgical management of stage I and II melanoma patients: Approach to the regional lymph node basin

The role for elective lymph node dissection in the management of clinically localized (Stage I and II) melanoma patients represents a long- standing controversy. Contemporary randomized elective lymph node dissection trials have been completed with recently presented results demonstrating some survival benefit for surgical therapy of micrometastases in specific subsets of patients. Lymphatic mapping and sentinel node biopsy offers a rational alternative to elective lymph node dissection for all high risk Stage I and II melanoma patients. Recent advances in lymphatic mapping techniques have resulted in improved identification of the sentinel node. Combined with advances in histologic evaluations of lymph nodes, accurate and minimally invasive mechanisms for assessing lymph node status are now available. This latter goal is critical in light of recently published data demonstrating improved survival with the use of high dose interferon alpha administered in the adjuvant setting for patients with nodal metastases.