Aims: the sentinel lymph node (SLN) biopsy technique has become a widely accepted procedure for staging the disease of melanoma patients who have clinically negative lymph nodes. SLN biopsy is usually recommended for patients with primary melanomas more than 1 mm in thickness and in patients with thin (< 1 mm) melanomas showing adverse prognostic factors such as Clark level IV or V invasion, ulceration or high mitotic rate. The study aims to determine the incidence of SLN positivity and the role of SLN biopsy in thin melanoma patients. Methods: from January 1999 to December 2007, 300 patients with invasive melanomas in every depth category (Breslow thickness range 0.15- 15 mm) underwent SLN biopsy. Eighty-two patients had thin melanomas. Result: nodal metastases were detected in 19.6% by SLN biopsy, and there were two sentinel positive thin-melanomas (1 metastases, 1 micro metastases) constituting 2.4 % of the thin melanomas cases. The two cases showed there were no primary tumours factors that would have predicted these metastases, with the exception of age (both 35 years old). In fact in both patients the Clark level of invasion was II, ulceration wasn’t present, the mitotic rate was low, 0.75 mm Breslow thickness in one case and 0.65 mm in the other. Each patient underwent complete lymph node dissection, the pathology showed 2 micro metastases in one case (total 14 lymph nodes) and no metastatic disease in the patient with micro-metastases. Us and PET were negative at 24 and 18 months respectively. Conclusion: nodal metastases in thin cutaneous melanoma is uncommon and no clinical-pathological factors were predictive of finding a positive SLN. Nevertheless SLN status remains the most prognostic factor in melanoma, so we routinely apply SLN surgical procedure in young thin melanoma patients regardless of the presence or absence of adverse prognostic factors.
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