e19002 Background: Sentinel node biopsy (SNB) is used in the management of melanoma patients without nodal metastases. Methods: From January 1, 1998 to December 31, 2011 we performed 182 SNBs at St. M. Goretti Hospital. Patients presented a primary melanoma, Breslow thickness equal to or higher than 1 mm, lower than 1 mm with regression and/or ulceration, and/or IV-V Clark level, and/or mitotic rate ≥ 1/mm2, according to the 7th edition melanoma staging system. All patients underwent pre-operative lymphoscintigraphy with intradermal injection of 50-70 MBq 99 mTc colloidal albumina particles, 50-80 nm size range, in 0.1-0.2 ml saline solution. We never used blue dye. All patients underwent surgical treatment 4-12 h. later. We performed SNB in day-surgery (DS) under local anaesthesia (LA). Surgery incision was 3-4 cm. This study was approved by an ethics committee, discussed with all patients and informed consent was obtained. Purpose of the study is to investigate the validity of this approach for quality of life and cost reduction. Results: 165 patients underwent SNB, 64 (38.7%) in the inguinal region, 83 (50.3%) in axilla, 1 (0.6%) in the popliteal region, 4 (2.4%) patients showed inguinal bilateral sentinel lymph-node (SLN), 6 (3.6%) axillary bilateral SLN, 4 (2.4%) axillary and 3 (1.8%) inguinal double SLN. The SLN identification rate was 100%. After surgery we distributed a questionnaire to the patients about the acceptability of this approach. In 32 patients SLN was positive. In these patients we performed radical lymphoadenectomy, 12 (37.5%) inguinal and 20 (62.5%) axillary. Conclusions: The results achieved are extremely accurate. This procedure is safe, well accepted by patients (98%), reported better quality of life. The oncological results are absolutely reliable. As regards hospital logistics, operations in DS and LA can be easily managed, leading to a significant cost reduction, 42.15% less expensive than the same operation performed under general anaesthesia.
Quality of Life Following Sentinel Node Biopsy for Primary Cutaneous Melanoma: Health Economic Implications
