Let's get back to basics in managing melanoma

doi:10.1136/bmj.39568.466910.80

BMJ 2008;336:1033 (10 May), doi:10.1136/bmj.39568.466910.80

Letters

Sentinel lymph node biopsy

Let’s get back to basics in managing melanoma

The first 150 words of the full text of this article appear below.

I find the debate about sentinel node biopsy puzzling.¹ Cliniciansare getting bogged down with this question while the fundamentalsof managing cutaneous melanoma are being neglected. A recentAustralian study showed that doctors perform poorly in key aspectsof managing this aggressive tumour.² Only a third of doctorsexcised cutaneous melanoma with the margins recommended by theAustralian guidelines—a third used larger margins and,more worrying, a third used narrower margins. Most doctors failedto check the skin at follow-up, and they often diagnosed suspiciouslesions by biopsy not local excision. Australian surgeons areslow to acquire dermoscopic skills that improve early diagnosisof melanoma. A patient with a thin melanoma is more likely todevelop another cutaneous primary than metastatic disease. Yetdermoscopy and skin checks are often neglected.

If surgeons used time spent doing sentinel lymph node biopsyin routinely examining the skin at follow-up, there would . . . [Full text of this article]

Anthony Dixon, censor

¹ Australasian College of Skin Cancer Medicine, Geelong, VIC 3216, Australia

anthony@skincanceronly.com