Role of Sentinel Node Biopsy Sentinel lymph node biopsy (SLNB) is a crucial staging procedure for melanoma: • • • Purpose: Determines whether melanoma has spread to regional lymph nodes. Technique: Radioactive tracer or dye injected near the primary tumor identifies the sentinel node, which is then surgically removed and examined for cancer cells. Implications: Guides further management decisions regarding lymph node dissection and adjuvant therapy. Local, Regional, and Systemic Therapy 1. Local Therapy: Surgical excision with adequate margins based on Breslow thickness. 2. Regional Therapy: o Lymph Node Dissection: Removal of affected regional lymph nodes if SLNB is positive. o Elective Lymph Node Dissection: For high-risk melanomas without clinical lymph node involvement. 3. Systemic Therapy: o Adjuvant Therapy: Interferon-alfa or immune checkpoint inhibitors (e.g., pembrolizumab, ipilimumab) for high-risk melanomas. o Targeted Therapy: BRAF inhibitors (e.g., vemurafenib) for tumors with BRAF mutations. o Chemotherapy: Reserved for advanced or metastatic disease not responsive to other therapies. Follow-Up of Patients Treated for Melanoma • • • Regular Skin Examinations: Every 3-12 months, depending on the risk category. Imaging: Periodic imaging scans (CT, MRI, PET) to monitor for recurrence or metastasis. Education: Sun protection measures and self-skin examinations. Principles of Management of Metastatic Melanoma Management of metastatic melanoma focuses on: 1. Targeted Therapy: BRAF inhibitors (e.g., vemurafenib) for BRAF-mutant melanomas. 2. Immunotherapy: Checkpoint inhibitors (e.g., pembrolizumab, nivolumab) to enhance immune response against melanoma cells. 3. Combination Therapies: Dual checkpoint blockade or combined targeted and immunotherapy approaches. 4. Palliative Care: Symptom management and supportive care to maintain quality of life. Conclusion Malignant melanoma represents a significant challenge in oncology, requiring comprehensive evaluation, staging, and treatment. Early detection, accurate staging, and personalized treatment strategies are essential for improving outcomes and managing both localized and metastatic disease effectively. Integration of surgical, systemic, and supportive therapies, along with vigilant follow-up, plays a crucial role in the management and long-term care of patients with melanoma.