Is sentinel node biopsy in melanoma a test or a treatment?BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f677 (Published 06 February 2013) Cite this as: BMJ 2013;346:f677
- Anthony J Dixon, professor1
Ten years ago we hoped sentinel lymph node biopsy (SNB) “treatment” would prolong life for patients with melanoma. Then the first Multicenter Selective Lymphadenectomy Trial (MSLT-1) failed to show a five year survival advantage.1 Now we talk of the SNB “test” offering some patients a more accurate survival prediction.
We advise our patients about the lack of evidence for a survival benefit of SNB and that we have no clear life prolonging treatment to offer if the test is positive. We explain that we remain unsure whether to remove the remaining nodes (while hoping MSLT-2 data might answer this question). We also explain that the test is an expensive operation, which is not always accurate and had a 10% complication rate in MSLT-1.2 3
As a junior doctor I was taught, “first, do no harm,” and that the fundamental purpose of a test was to direct intervention. One hospital made juniors tick a box confirming, “Future management of our patient is predicated on this test” before we signed a request form. SNB tests these boundaries.4
Adverse events after SNB include anaphylaxis, permanent nerve damage, and lympho-oedema.5 When I see such disabling events, I am reminded of the importance of detailing the pros and cons to new patients.
We hope that the 10 year MSLT-1 data will show a survival benefit in the intervention group. Then we could start talking of SNB as a treatment again. It is imperative that the full data are published promptly.
Cite this as: BMJ 2013;346:f677
Competing interests: None declared.