Detecting melanoma's reach

December 01, 2012
Dr. James G. Jakowatz

The physicians at the UCI Health Melanoma Center specialize in the most advanced methods for determining the spread of this aggressive skin cancer beyond the initial site.

One of the best predictors of the spread of melanoma is determining whether the disease involves lymph nodes, says Dr. James G. Jakowatz, a surgical oncologist and director of the Melanoma Center. Historically, high-risk melanoma patients had to undergo radical lymph node dissections to discover whether any lymph nodes were involved.

Now, says Jakowatz, UCI Health melanoma specialists are able to find and biopsy only the lymph nodes most likely to harbor melanoma cells. This process, known as sentinel lymph node mapping, usually involves removing one to three lymph nodes, rather than a radical procedure to remove all of the lymph nodes in either the armpit or groin area. If no disease is found in the sentinel node(s), no further dissection is needed.

Sentinel lymph node mapping involves an injection—performed by a UC Irvine molecular imaging specialist—of a tiny amount of radioactive material at the site where the melanoma has started to grow.

Blue dye also is injected into the patient just before the biopsy procedure. A sterile hand-held radiation detector is used to isolate the sentinel node that registers radioactivity. The sentinel lymph node(s) with detectible radioactivity also turns blue, which provides double confirmation of the involved node(s).

Usually only a small incision is needed to remove the sentinel node, leaving the remaining lymph nodes intact. The radioactive and blue node(s) are sent to a specialist in dermatologic pathology for in-depth examination, which takes about five days. Other methods such as “frozen section” diagnosis of node tissue are not accurate enough to find tiny deposits of melanoma cells.

Jakowatz was the first to use sentinel lymph node mapping for melanoma diagnosis in Orange County. He has performed more than 1,000 of these procedures at UC Irvine Medical Center. Dr. Maki Yamamoto, who trained with Jakowatz, has performed many of these procedures as well.

Sentinel lymph node mapping and biopsy is the best, most advanced staging procedure for early detection of melanoma spread, enhancing survival and preventing unnecessary radical surgery, and it is one of the great strengths of the Melanoma Center, Jakowatz says.

Learn more about Dr. Jakowatz ›

Learn more about Dr. Yamamoto ›

For more information or to make an appointment at the Melanoma Center, call 714-456-8000.