前哨淋巴结活检用于皮肤黑色素瘤

A 38-year-old woman presented to her dermatologist with a 2-month history of changes in a mole on her right upper back. The mole had been present for a few years, but recently the patient had noticed episodes of itching and observed blood on her blouse. On skin examination, this pigmented lesion was 8mm in diameter and had irregular borders and variegated color. An excisional biopsy was performed; pathological examination revealed a superficial spreading melanoma, 2.8mm thick (i.e., in depth), with ulceration and six mitotic figures per square millimeter. Subsequent examination of the patient revealed a healing biopsy site over the right upper back. There was no clinical adenopathy and no evidence of in-transit or satellite metastases. The patient had no specific symptoms indicative of metastatic disease. A surgical oncologist was consulted, who recommended that the patient undergo wide excision of the primary tumor and sentinel-lymph-node biopsy in the same operative setting.