Lymphatic Mapping Sentinel Lymph Node Biopsy

• Sentinel Node: first echelon node that drains primary tumor

• Lymphoscintigraphy and Lymphatic Mapping: localizes the sentinel node and lymphatic drainage pattern

• Technique: preoperatively undergo a lymphoscintigraphy to identify region of the draining basin and sentinel node, interoperatively inject lymphozarin dye intradermally to visualize sentinel node during dissection, confirm sentinel node by utilizing a radioactive probe (P-

probe), biopsy sentinel node and send for frozen section (4—8% false-positive rate)

• if node is positive for melanoma should undergo a neck dissection and consideration for interferon therapy

• if node is negative for melanoma no neck dissection required, may undergo neck dissection and consideration for interferon therapy if clinical nodes develop

• frozen section positive for tumor 15—20% of time

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