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Donald L. Morton, MD; Duan-Ren Wen, MD; Jan H. Wong, MD; James S. Economou, MD, PhD; Leslie A. Cagle, MD; F. Kristian Storm, MD; Leland J. Foshag, MD; Alistair J. Cochran, MD

Arch Surg. 1992;127(4):392-399.

Abstract
• The initial route of metastases in most patients with melanoma is via the lymphatics to the regional nodes. However, routine lymphadenectomy for patients with clinical stage I melanoma remains controversial because most of these patients do not have nodal metastases, are unlikely to benefit from the operation, and may suffer troublesome postoperative edema of the limbs. A new procedure was developed using vital dyes that permits intraoperative identification of the sentinel lymph node, the lymph node nearest the site of the primary melanoma, on the direct drainage pathway. The most likely site of early metastases, the sentinel node can be removed for immediate intraoperative study to identify clinically occult melanoma cells. We successfully identified the sentinel node(s) in 194 of 237 lymphatic basins and detected metastases in 40 specimens (21%) on examination of routine hematoxylin-eosin—stained slides (12%) or exclusively in immunohistochemically stained preparations (9%). Metastases were present in 47 (18%) of 259 sentinel nodes, while nonsentinel nodes were the sole site of metastasis in only two of 3079 nodes from 194 lymphadenectomy specimens that had an identifiable sentinel node, a false-negative rate of less than 1%. Thus, this technique identifies, with a high degree of accuracy, patients with early stage melanoma who have nodal metastases and are likely to benefit from radical lymphadenectomy.

(Arch Surg. 1992;127:392-399)

Author Affiliations
From the John Wayne Institute for Cancer Treatment and Research, St John's Hospital and Health Center, Santa Monica, Calif (Drs Morton, Wen, and Foshag); and the Division of Surgical Oncology, UCLA School of Medicine (Drs Wong, Economou, Cagle, Storm, and Cochran). Dr Storm is now with the Department of Surgery, Division of Oncology, University of Wisconsin School of Medicine, Madison.

Footnotes
Accepted for publication November 2, 1991.

Presented at the Society of Surgical Oncology 43rd Annual Cancer Symposium, Washington, DC, May 22, 1990.

Reprint requests to John Wayne Institute for Cancer Treatment and Research, St John's Hospital and Health Center, 1328 22nd St, Santa Monica, CA 90404 (Dr Morton).

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