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One day or 2 4 h before surgery, dynamic lymphoscintigraphy is performed by intradermal injection of 99mTc-labelled colloid particles of human serum albumin (as lymphoscint, nanocoll or albu-Res) into both sides of the melanoma excision scar.
Four to 6 h before the operation, 70 MBq ICG 99mTc-nanocolloid ICG 99mTc-nanocolloidd intradermally in four deposits around the scar of the primary melanoma excision.
However, with the increasing use of sentinel node biopsy technique in primary 'risk melanomas' at time of primary melanoma excision (Reintgen et al, 1998), lymph node sonography may turn out to be redundant.
Approximately 5 h before surgery, the hybrid nanocolloid labeled with indocyanine green (ICG) and technetium-99m (99mTc) was injected intradermally in four deposits around the scar of the primary melanoma excision.
According to the NCI surgical excision is a method of choice for stage 0 melanoma, excision and lymph node management for stages I, II, and resectable III melanoma, and immunotherapy, chemotherapy, targeted therapy, or palliative local therapy for unresectable stage III, stage IV, and recurrent melanoma [ 5].
Sensitivity specificity curves (figure 2), ROC curves and AUCs indicate that the Shields Index achieves the greatest discriminatory power, with AJCC staging performing least well in this group of patients who were without lymph node or other metastasis at the time of melanoma excision.
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Some specimens (e.g. cervical cone biopsies, primary melanoma excisions) may be totally submitted to document minute foci of tumour or depth of invasion.
3 Unfortunately, despite defined surgical treatment of the primary melanoma with excision margins of 1 or 2 cm, approximately 16 28 % of patients develop recurrent disease.
4, 5 Possible explanations for the absence of a primary tumor are spontaneous regression, unidentified primary melanoma, previous excision of what was considered a benign lesion or a malignant transformation of an ectopic nodal melanocyte.
Sections of melanomas, excised by wide local excision, fixed in paraformaldehyde, cut into ~2 mm thick samples, and paraffin embedded were used to calculate Breslow thickness〈3〉.
In summary, this means that in general, surgical management of primary melanoma consists of excision and primary closure.
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