Can multispectral optoacoustic tomography replace sentinel lymph biopsy in melanoma?

With the establishment of the concept of sentinel lymph in the draining regional nodes for melanoma by Morton (1) in 1992, the surgical world has undergone a revolution from therapeutically resecting regional nodes, an established approach since the days of Halsted (2) in 1898 to a much less morbid procedure of selectively removing the relevant sentinel lymph nodes in the regional basin (3) being indicated for primary invasive melanoma according to the National Comprehensive Cancer Network (4). Staging of the regional nodal basin by SLN biopsy has become the standard of care for assessing the status of the regional lymph node for melanoma (3) and breast cancer (5). About 80% of melanoma patients will be spared from a more radical regional lymph node dissection. The only way to assess the sentinel lymph nodes still requires a surgical intervention. The challenge is to assess the clinically non-palpable sentinel lymph nodes using a non-invasive method.