For Years, We Have Known that the Vast Majority of Cancers Spread Through the Lymphatic System and from There, Can Spread to Other Vital Organs.

In the early 1990s, Dr. Donald Morton described a technique to identify the first lymph nodes in that sequence of spread that changed the practice of surgical oncology. In the past, patients with intermediate-risk melanoma underwent complete removal of all regional lymph nodes, a procedure that has a moderate complication rate, like lymphedema, nerve injuries and wound complications. The procedure Dr. Morton and the John Wayne Cancer Institute pioneered uses dye and radiotracers to allow the surgeon to locate and then remove these key lymph nodes, termed sentinel lymph node(s). These can then be examined under a microscope to determine if there has been any spread of the tumor outside of the primary site.

Importantly, this information provides many benefits to the patient.

  • It can potentially minimize the extent of the surgery needed
  • It decreases the risk for long term complications that accompany a more extensive surgery
  • It provides better staging and prognostic information to help guide treatment decisions
  • It also has been shown to even improve the patients survival

The procedure is minimally invasive and is done on an outpatient basis. In some cases, the larger operation may still be needed, but four out of five patients can be spared. The sentinel node technique has become the international medical standard for melanoma surgery, and is being adapted to many other cancers .

Sentinel Node Biopsy Technique

The technique involves injecting a blue dye and radioisotope substance into the lymphatic system near the tumor. These tracers pass through the same pathways (lymphatic channels) that tumor cells might use and travels to the first, at-risk lymph node. This is typically done the same day as the surgery in the radiology department, where the tracer is placed in the area around the melanoma. The blue dye is injected in the operating room once the patient is under anesthesia.

Our center has state of the art detection tools to use in the operating room to accurately detect the sentinel lymph node.These intra-operative tools detect the radioactive tracers that migrate to the draining lymph nodes. These node also frequently turn blue from the dye that is injected.

This process usually find one to three lymph nodes, although more could be found. These lymph nodes are then sent to pathology for examination.

Our world-class pathologist then carefully examine each lymph node for signs of melanoma cells.

if that first lymph node is clear, it means the other lymph nodes in the same area should be clear as well, and the likelihood of the melanoma recurring in lymph nodes or elsewhere in the body is markedly less. If the lymph node shows spread of melanoma, it suggests higher risks that may require more aggressive treatment.

If You Receive a Diagnosis of Melanoma, Your Initial Treatment Can Make All the Difference.

The Melanoma, Skin and Soft Tissue Tumors Center of Excellence at the John Wayne Cancer Institute at Providence Saint John’s is one of the most experienced centers in the world. Our physicians are comfortable selecting the best treatment option, even for unusual cases. Contact us today to schedule an appointment.