Senator John McCain has endured more pain and suffering than most people can ever imagine. His courage and bravery, both in battle and life, are without question. Now he faces another difficult battle, a battle with melanoma. He had a prior melanoma removed in the past. Now, he has two new skin melanomas. His physicians elected to do a lymph node dissection to see whether the melanoma metastasized or spread. These regional lymph node dissections are becoming increasingly common for the treatment of early stage melanoma. The pathologist plays a key role in the treatment.
Most commonly, a technique known as a sentinel lymph node dissection is performed. A dye which may be labeled with a radioactive tag is injected into the melanoma site. This dye is immediately picked up by the body's lymphatic system and drains to the regional lymph nodes. This drainage route is the route that melanoma cells would follow if metastasis were to occur. Melanoma tends to spread in succession from one lymph node chain to another but usually involves the first or sentinel node of a chain before spreading to the rest of the lymph nodes within the chain. If this sentinel node can be identified by the dye, the surgeon will remove it and send it to the pathologist for an intraoperative frozen section. If the pathologist indicates the melanoma has spread to this sentinel lymph node, the surgeon will proceed to remove all of the other lymph nodes within that chain. If the pathologist indicates the lymph node is negative and clear of melanoma, the surgeon will stop. In this way, a patient may be spared the potential morbidity of a complete lymph node dissection.
The pathologist will process the tissue and perform multiple step sections and special stains, utilizing antibodies directed against different antigens of the melanoma cells. In this manner, any melanoma cell that was not present on the initial frozen section, will be identified on these permanent sections. This is the reason why on the day of Senator McCain's surgery, a preliminary and not final result of no metastatic spread to the lymph nodes was given. The pathologist still needed to process the remaining tissue and examine the permanent sections the next day.
Our prayers are with Senator McCain and his family. Once again, his courage is evident as he helps us to focus attention on malignant melanoma and the importance of early recognition.
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Special Stains (Immunohistochemistry)
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Commonly Used Terms
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Last Updated 8/1/2001
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