![]() Anesthesia (numbness) of the neck skin, earlobe, and possibly the tongue.VII: marginal mandibular branch weakness and rare total facial paralysis unless the neck disease is high in zone II.Cranial nerve deficits (emphasize if disease is near a particular nerve).Chylous fistula (at risk of Level IV dissection).Shoulder weakness, adhesive capsulitis, pain.Depending on the site of the sentinel node, the complications may be similar to those described for neck dissection or parotidectomy:.Explain risks and potential complications: Bleeding, infection, reaction to the anesthesia, damage to adjacent structures.Discuss the possibility of resection of more than one lymph node biopsy and creating more than one incision (removal of greater than or equal to 3 SLNs leads to lower chance of additional positive non-SLN).Discuss the possibility of requiring a Parotidectomy with Facial Nerve Dissection.It should be explained to the patient that a sentinel lymph node biopsy is a staging procedure, and the current standard (pending results of the multi-center selective lymphadenectomy trial-2 - aka MSLT-2) usually directs the finding of a positive SLN to a completion lymphadenectomy, possibly with the need for further surgery, immunotherapy, chemotherapy, and/or radiation therapy.Describe procedure including the benefits.Other services as dictated by comorbidity and extent of disease.Ensures discussion at melanoma tumor board.Permits consideration for study purposes (including tissue repository).For all cases other than the most superficial (T1).Useful particularly in identifying intra- and peri-parotid nodes to plan surgical access for sentinel node dissection.Primary goal: permit co-registration (usually done visually with surgeon present) to correlate with lymphoscintigram immediately preoperatively.Thin cut CT of the H+N with contrast prior to lymphoscintigram - most useful in the parotid region.Tumor Board Discussion (special twice monthly Thursday 7 am Melanoma Tumor Board).If the biopsy shows melanoma, leave the sutures in place until the time of definitive resection for use as marker of the site.Photography before biopsy is useful (sometimes critical) to document original location and appearance.Only 1 to 2 mm margins should be obtained around the lesion in order to permit subsequent accurate lymphoscintigraphy.Biopsy of the suspicious lesion is best done with an excision (if possible) - punch or ellipse of the thickest portion of a larger lesion.Identification of homogenous populations allows for more powerful clinical trials, and ideally, a greater likely hood of of more effective adjuvant therapies.SLNB provides the most accurate means of regional staging, which is recognized as the most important prognostic factor in melanoma.SLNB identifies patients who are candidates for adjuvant treatment (see: Melanoma (Evaluation and Management)).SLNB facilitates identify patients with nodal metastasis (important prognostic factor), who then may benefit from early therapeutic lymph node dissection (TLND).SLNB provides important prognostic information to the physician and patient in guiding subsequent treatment options.RATIONALE (as per McMasters, KM, et al 2001).Currently felt that for pure desmoplastic melanoma of the head and neck, the high incidence of negative sentinel lymph node biopsies as well as the low incidence of neck recurrence, argues against use of sentinel lymph node biopsy for this rare subset of melanoma (Eppsteiner et al 2012, Mohebati et al 2012).Melanoma with status other than Tis (melanom in situ) or T1a.Thin melanoma Breslow depth of invasion greater than 1 mm - may consider in thinner (>0.75 mm) melanoma in high risk sites.Malignant melanoma (see TNM specific indications at: Melanoma (Evaluation and Management).See discussion re: Controversy Regarding Value of SLN Biopsy (at bottom of page) See also: Lymphoseek also called technetium Tc 99m tilmanocept See also: Case Example Sentinel Lymph Node Biopsy
0 Comments
Leave a Reply. |