Feature Overtreatment

Sentinel node biopsy for melanoma: unnecessary treatment?

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.e8645 (Published 08 January 2013) Cite this as: BMJ 2013;346:e8645

Re: Sentinel node biopsy for melanoma: unnecessary treatment?

It does rather seem that the responses published so far are as weighted as the writers claim Torjesen's article to be. In reality she appears only to have been pointing out that trial results are over-due and seeking reasons for the unexplained delay. Why should pointing out that a procedure which if taken to its conclusion, ie the complete clearance of a regional lymph basin, results in considerable morbidity be reason to criticise the author of this piece?

The fact is that lymphadenectomy is a surgically brutal procedure which on present knowledge conveys no survival advantage over waiting until true lymphadenopathy is detected by less invasive methods. But what is most disturbing about SLNB is that patients who are offered the procedure rarely appear to have it spelled out to them in single syllables that there is no proven survival advantage. Moreover, any patient given a diagnosis of melanoma will be in a state of mental turmoil which makes it almost impossible for them to either assess the offer of SLNB or to resist it. The suggestion to patients that the procedure will help staging or research constitutes a subtle form of blackmail which caring clinicans really ought to avoid. Credit must surely go to Retsas, an experienced oncologist for his point of view.

Competing interests: No competing interests

17 January 2013
Peter J Mahaffey
Consultant Plastic Surgeon
Bedford Hospital
Kempston Rd, Bedford, MK42 9DJ
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