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Sentinel-Lymph-Node-Dissection (SLND)

Malignant melanoma is among the most aggressive tumors, with its incidence worldwide rapidly growing over the past decades. After the excision of a malignant melanoma further thearpeutic management depends on the depth of invasion of the tumor into the skin (Breslow-Index und Clark-Level). Should the Breslow-Index (tumorinvasion, thickness) exceed 1mm, extirpation (removal) of the sentinel-lymph-node is recommended.

The sentinel-lymph-node (SLN) is the first draining lymph node of the regional lymph nodes.

Prior to the operation, the sentinel-lymph-node needs to be identified; this is made possible by injecting a radioactively marked (99mTc) kolloid suspension peritumorally (around the tumor). Preoperatively, also a blue dye is injected around the tumor to allow for identification of the SLN intraoperatively both visually and by gammy probe.
The SLN is then excised and histologically examined. Should the SLN be positive for tumor cells, the entire regional lymph node area is removed (therapeutic lymph-node-dissection, TLND). Whether this radical procedure improves survival rates, is currently being investigated in international multicenter studies.