[Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

[The role of sentinel lymph node biopsy in the diagnosis and prognosis of malignant melanoma]

Sentinel lymph node biopsy was introduced into the management of cancer patients 20 years ago. Most hospitals now currently use the technique as a routine diagnostic tool in patients with localized malignant melanoma. However, the technique is complex and numerous details need to be determined and assessed to provide reliable diagnostic and prognostic information. In addition, the introduction of immunohistochemical and molecular techniques in the last decade has extended the information provided by the study of sentinel lymph nodes and created valuable opportunities for investigating the pathogenesis of this type of cancer. The aim of this review is to offer the reader a detailed analysis of the most important studies in the literature and the factors that should currently be considered in determining the indication for sentinel lymph node biopsy, performing the procedure correctly, and interpreting the findings in patients with malignant melanoma.

[Lymphoscintigraphy in the study of lymphatic drainage patterns in patients with melanoma]

BACKGROUND

In order to plan the pertinent surgical technique for each patient with melanoma or other skin malignancies, it is mandatory to identify those lymphatic basins at risk for metastases. The advent of radiotracers for functional studies of the cutaneous lymphatic system during the last decade has resulted in the disclosure of an unexpected interindividual variability of the lymphatic drainage in both head and neck and trunk.

OBJECTIVE

To ascertain the usefulness of lymphoscintigraphy for depicting the cutaneous lymphatic draining basins in patients with primary melanoma of the head, trunk and limbs, and to compare the observed lymphatic drain with the expected pattern of lymph flow according to the classical anatomical studies.

MATERIAL AND METHODS

Prospective study in a university hospital (Barcelones Nord area). Consecutive patients with the diagnosis of cutaneous melanoma were recruited after excisional biopsy of the primary tumor. Every patient was intradermally injected with rhenium-sulfide colloids or colloidal technetium labelled with Tc-99m in four quadrant doses of 0.3 ml around the lesions or its excisional scar. Scintigraphic imaging of the migrating radiotracer resulted in a flow pattern that was compared with its "classical" expected counterpart.

RESULTS

Altogether, 55 lesions were studied, including 9 in the head, 21 in the trunk and 25 in the limbs (7 upper and 18 lower). The scintigraphic drain pattern did not match the expected classical pattern in 37.0% of the lesions overall (14% upper limbs, 42% truncal lesions out from an area 2.5 cm at both sides of Sapey's line or the midline, 16.6% lower limbs and 89% head and neck).

CONCLUSIONS

Lymphatic drain of the skin shows a very high intrapersonal variability leading to the need for an individual work-up in order to know the lymphatic basins at risk for metastases. The high rate of unexpected or non-matching patterns casts some doubts over those previous studies that did not include lymphoscintigraphy on a patient-basis.

Generalized nevus spilus and nevus anemicus in a patient with a primary lymphedema: a new type of phakomatosis pigmentovascularis?

A patient with a generalized nevus spilus associated with a nevus anemicus and primary lymphedema is reported. We believe that this association does not reflect the merely coincidental coexistence of three kinds of anomalies but that it may represent a new type of phakomatosis pigmentovascularis.