Letters Sentinel node biopsy for melanoma

Call for a balanced view on sentinel node biopsy for melanoma

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f648 (Published 06 February 2013) Cite this as: BMJ 2013;346:f648
  1. Jenny L C Geh, consultant plastic surgeon1,
  2. Ciaran Healy, consultant plastic surgeon1,
  3. Katie Lacy, consultant dermatologist1,
  4. Mary Wain, consultant dermatologist1,
  5. Natalie Attard, consultant dermatologist1,
  6. Eduardo Calonje, consultant dermatopathologist,
  7. Mark Harries, consultant oncologist1,
  8. Michael O’Doherty, consultant in nuclear medicine1,
  9. Danuta Orlowska, clinical psychologist for skin cancer service1
  1. 1Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London SE1 7EH, UK
  1. jenny.geh{at}gstt.nhs.uk

The title of Torjesen’s article could be misleading.1 Sentinel node biopsy (SNB) is a staging tool used to provide patients with the best available information,2 and is a well established prognostic test.

Our research shows that patients want information on prognosis.3 Lymph node status is the most meaningful prognostic indicator and SNB the most sensitive test. Perhaps the addition of the word “test” would be helpful. Early identification and removal of affected lymph node basins can provide local disease control and psychological benefit for patients. The first Multicenter Selective Lymphadenectomy Trial found some benefit in terms of disease-free survival, which should not be ignored.

Arguments for and against the use of SNB have been carefully considered by numerous groups around the world. The usefulness, accuracy, and low risk of harm are well established. Early clearance of microscopically affected, but non-palpable, lymph node basins with lower tumour load has reduced the morbidity of block dissection surgery.4

Breast cancer is a different disease and the technique itself is different from melanoma SNB. This can lead to confusion for those reviewing the publications on SNB.

SNB for melanoma is offered to eligible patients at Guy’s and St Thomas’ melanoma clinic. The reasons, risks, benefits, and information on appropriate clinical trials are given, as recommended by the recent best practice pathway.5

Finally, and crucially, we perform SNB to enable accurate staging and enrolment of patients to adjuvant drug trials and other research trials with the aim of improving overall treatment. We urge readers to take a more balanced view than that presented by Torjesen.


Cite this as: BMJ 2013;346:f648