The Risk of In-Transit Melanoma Metastasis Depends on Tumor Biology and Not the Surgical Approach to Regional Lymph Nodes

Although the majority of patients newly diagnosed with cutaneous melanoma present with clinically negative regional nodal basins, many of these patients harbor occult regional lymph node metastases. Historically, the initial treatment strategy for patients with clinically negative regional lymph nodes has been controversial. Treatments have included elective dissection, the goal of which was improved survival, and observation followed by dissection when clinical relapse developed. A more rational selective approach, involving lymphatic mapping and sentinel lymph node biopsy (SLNB), has now been widely adopted. SLNB is a minimally invasive technique for identifying the approximately 20% of patients who harbor occult metastatic disease and who may therefore benefit from comple