The saga of lymph node surgery in malignant melanoma: a history repeating itself in gynecologic oncology

In view of the high morbidity to complete lymphadenectomy, the sentinel node procedure is currently being investigated in different cancers with the aim of reducing morbidity and of achieving oncological outcomes similar to complete lymphadenectomy. In this review, a parallel will be drawn between the evolutions of the place of lymph node surgery in the management of melanoma and gynecologic cancers. Currently, in the case of cutaneous melanoma, the indications of lymph node surgery are becoming increasingly rare. In contrast with the scarce available evidence in gynecologic cancer, this trend is supported by multicenter randomized studies with a large number of patients for cutaneous melanoma. The second difference is the demonstrated therapeutic benefit of immunotherapies and targeted therapies in cutaneous melanoma, which are less significant in gynecological cancers for which the mainstay of treatment is surgery. According to this review, it seems that in gynecologic oncology, we could in the next decades follow the same pathway currently taken in the management of lymph nodes in malignant melanoma.