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BASICS IN DERMATOLOGIC SURGERY/ SCALP MELANOMA/ HEAD AND NECK MELANOMA:
procedure for staging melanoma, including on the scalp, to determine if it has spread to nearby lymph nodes. It involves identifying and removing the first lymph nodes that receive drainage from the tumor to check for cancer cells. For scalp melanoma, this procedure is safe and accurate, providing important information for prognosis and further treatment decisions.

What is a sentinel lymph node biopsy?
Purpose: To check if melanoma has spread from the primary site to the lymph nodes.
Procedure: A radioactive tracer and/or blue dye is injected near the melanoma. The surgeon then uses this to find and remove the “sentinel” lymph nodes, which are the first ones in the lymphatic system to receive drainage from the tumor.
Why it’s done: The status of the sentinel lymph nodes is a key factor in predicting melanoma recurrence and survival.
What happens next: If the sentinel nodes are cancerous, it indicates the cancer has spread, and the patient may need further treatment. If the nodes are clear, it may mean the cancer has not spread, and this can help avoid more extensive surgery.
Specifics for scalp melanoma
Head and neck melanoma: The head and neck region, including the scalp, has many lymph nodes, which can make the procedure more complex. However, studies show that SLNB is accurate and safe for head and neck melanomas.
Identifying sentinel nodes: Surgeons use a gamma probe to confirm which nodes are the sentinel nodes, as there are numerous lymph nodes in this area.
Prognostic information: Despite some earlier reports of potential challenges, SLNB has been shown to provide crucial prognostic information for head and neck melanoma, similar to other body sites.
When is it performed?
Indications: The need for an SLNB depends on the melanoma’s characteristics, such as its thickness (Breslow depth).
Showing here the result after 2 surgical sessions and the removal of the sentinel LN of the neck during the second session , which we have performed under general
Anesthesia.
Melanoma seems
To be a global
Problem and clinicians has to be aware how to
Manage it. Surgical rules and operative margins are important part of this management when we want to be successful.
Following the AJCC / EJC rules – narrow surgical margins were applied. Second session follows.