Brancaccio Gabriella, Briatico Giulia, Scharf Camila, Colella Giuseppe, Docimo Giovanni, Docimo Ludovico, Faenza Mario, Iovino Francesco, Tolone Salvatore, Verolino Pasquale, Napolitano Stefania, Troiani Teresa, Ronchi Andrea, Franco Renato, Argenziano Giuseppe
Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
Multidisciplinary Department of Medical, Surgical and Dental Specialties, Oral and Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
Dermatol Pract Concept. 2024 Jan 1;14(1):e2024038. doi: 10.5826/dpc.1401a38.
Sentinel lymph node biopsy (SLNB) is a surgical procedure aimed to detect nodal metastases in patients with clinically occult disease. Since the advent of new systemic therapies, its role in melanoma has been extensively debated over the last years. In this article, three possible scenarios are discussed, considering the SLNB impact on the management of melanoma patients. First, pT1b and pT2a patients with negative SLNB (stages IA and IB) and those with positive SLNB (stage IIIA) would all not benefit from adjuvant treatment. Therefore, SLNB might be avoided in these categories of patients. Second, in IIB and IIC, melanoma patients are already candidates for adjuvant treatment; therefore, SLNB in patients with T3b, T4a, or T4b melanoma would not change treatment decisions. On the other end of the spectrum, patients with pT2b and pT3a melanomas (clinical stage IIA) represent the only two groups whose management would be significantly affected by the SLNB status, being adjuvant therapy only indicated for SLN-positive patients. Further studies are needed to investigate which melanoma patient deserves SLNB.
前哨淋巴结活检（SLNB）是一种外科手术，旨在检测临床隐匿性疾病患者的淋巴结转移情况。自新型全身治疗方法出现以来，其在黑色素瘤中的作用在过去几年中一直备受争议。在本文中，考虑到SLNB对黑色素瘤患者管理的影响，讨论了三种可能的情况。首先，前哨淋巴结活检阴性的pT1b和pT2a患者（IA期和IB期）以及前哨淋巴结活检阳性的患者（IIIA期）都不会从辅助治疗中获益。因此，在这些类型的患者中可以避免进行SLNB。其次，在IIB期和IIC期，黑色素瘤患者已经是辅助治疗的候选者；因此，T3b、T4a或T4b黑色素瘤患者的SLNB不会改变治疗决策。在另一个极端情况下，pT2b和pT3a黑色素瘤患者（临床IIA期）是仅有的两组其管理会受到SLNB状态显著影响的患者，辅助治疗仅适用于前哨淋巴结阳性的患者。需要进一步研究来调查哪些黑色素瘤患者值得进行SLNB。
