Regional lymph node assessment for conjunctival melanoma: sentinel lymph node biopsy and positron emission tomography

Regional lymph nodes (parotid, submandibular, and cervical nodes) are the site of first metasatasis in the majority of patients with conjunctival melanoma. The risk of metastasis increases with tumour thickness (Breslow equivalent) and palpebral location. Sentinel lymph node (SLN) biopsy can identify patients who harbour microscopic metastasis in the regional lymph nodes and thus can select patients who might benefit from additional surgical treatment of their nodal metastasis. The value of PET as a routine staging test for conjunctival melanoma seems more limited, but it can be used to find additional sites of distant metastasis in patients with a positive SLN and to assess response to treatment in patients with known metastatic disease.