![]() 4, 6 In contrast, 99mTc-tilmanocept (TcTM) is a small (7 nm) radiotracer approved by the Food and Drug Administration in 2013 that targets the mannose CD206 receptor within the macrophages of lymph nodes. 4, 5 Historically, the standard radiotracer used in the United States has been Tc-99m sulfur colloid (TcSC), which is passively transported by the lymphatic system based on molecular weight (100–220 nm). 4 An ideal lymph node mapping agent would meet the following criteria: (1) rapid clearance from injection site, (2) rapid uptake and high retention within the first draining lymph node, and (3) low uptake by distal lymph nodes. Lymphatic mapping can be performed with radiotracers, vital blue dye, or both and across the United States and Europe there is not a standardized agent. 2 The National Comprehensive Cancer Network recommends considering SLNB in all patients with clinical stage 1B or II melanoma based on the fact that in these clinical stages the probability of a positive SLNB is over 10% and sentinel lymph node (SLN) status is the strongest predictor of survival. 1 Sentinel lymph node biopsy (SLNB) is routinely performed to identify and sample tumor-draining lymph nodes in the setting of intermediate- and high-risk melanomas to provide important prognostic information and more recently to guide decisions about adjuvant systemic therapy. There were an estimated 100,350 new cases of melanoma in 2020 with a significant difference in survival if the cancer had progressed locally versus regionally (99.0% vs.
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