The incidence of melanoma is increasing by 1:1500 in 1935 to 1:75 in 2000. However, there is five-year survival improvement with decrease in mortality due to early diagnosis. Initial staging is based on signs and symptoms showing metastatic disease. Special care should be taken at lymphatic examination. The two most powerful independent prognostic variables are tumor thickness and ulceration. In patients with nodal metastasis, the three most powerful prognostic factors are number of positive nodes, tumor burden and the presence or absence of ulceration of primary lesion. Great differences exist in survival between patients with melanoma metastasis in visceral sites and those with metastasis in no visceral sites. Patients with lung as the only site of visceral metastasis had a better survival compared with other visceral sites. In many large series high DHL level has been shown to be a consistent, independent, and powerful prognostic factor in patients with stage IV disease. The lack of treatment pattern in melanoma has lead some patients to a bad prognosis because an error in the initial approach. The analysis of the sentinel lymph node techniques was included in the staging and therapeutics decision of melanoma patient. Treatment has changed during the years and the purpose of this paper is present a review reinforcing conducts, based on literature.
Melanoma; Sentinel lymph node; Combined modality therapy; Clinical protocols; Immunotherapy
