With the incidence of malignant melanoma lung cancer and breast cancer currently increasing, physicians everywhere encounter a sense of urgency in creating clinical guidelines with which to treat patients harboring this potentially fatal disease. If detected early enough, a melanoma can be classified as “thin” (ie, less than 0.76 mm in thickness) and is considered to be curable with simple surgical techniques. The problem arises, however, when a melanoma has invaded into the deeper dermis. With increasing melanoma thickness there is a concomitant risk for regional and distant metastases, and methods of staging patients at risk for recurrence have historically proven controversial. In the surgical management of malignant melanoma, physicians face the dilemma of performing an elective lymph node dissection (ELND) or following the “wait and watch” method of observing the regional nodal basin. Opponents of ELND highlight the morbidity of the procedure and prefer instead to follow the patient closely and perform a therapeutic lymph node dissection (TLND) only when nodal disease becomes clinically evident.<sup>18Morton D.L., Wen D.-R., Wong J.H., e al. Technical details of intraoperative lymphatic mapping for early stage melanoma Arch Surg 1992 ;  127 : 392-399

Cliccare qui per andare alla sezione Riferimenti</sup> Those supporting ELND argue that the procedure is useful as a nodal staging procedure and as a method by which to remove occult disease, which will go untreated if the physician directs surgical management solely on the presence of palpable disease. They point out that once nodal involvement is clinically detected, disease may have already metastasized to higher order nodes or distant sites.<sup>18Morton D.L., Wen D.-R., Wong J.H., e al. Technical details of intraoperative lymphatic mapping for early stage melanoma Arch Surg 1992 ;  127 : 392-399

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This article reviews selective lymphadenectomy, otherwise known as sentinel lymph node biopsy, as a compromise between the two traditional alternatives of (1) ELND, or (2) observation of the regional nodal basin followed by TLND once disease becomes clinically apparent. This procedure becomes more important in light of the recently published findings by the Eastern Cooperative Oncology Group (ECOG) Trial 1684<sup>14Kirkwood J.M., Strawderman M.H., Ernstoff M.S., e al. Adjuvant therapy of high-risk resected cutaneous melanoma. The Eastern Cooperative Oncology Group Trial EST 1684 J Clin Oncol 1996 ;  14 : 7-17

Cliccare qui per andare alla sezione Riferimenti</sup> and the Intergroup Melanoma Trial<sup>7Balch C.M., Soong S.-J., Bartolucci A.A., e al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger Ann Surg 1996 ;  224 : 255-266 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> that ELND and interferon alfa-2b (the first effective adjuvant therapy for the patient with melanoma) may improve prognosis in certain subgroups of patients.