Editorials

Sentinel lymph node biopsy in melanoma

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5940 (Published 10 November 2015) Cite this as: BMJ 2015;351:h5940
  1. Michael Bigby, associate professor of dermatology1,
  2. Catalin Popescu, associate professor of dermatology2
  1. 1Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2Department of Dermatology, Colentina Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  1. Correspondence to: M Bigby mbigby{at}bidmc.harvard.edu

Useful only to a small minority of patients who have the procedure

There are two diametrically opposed positions on the role of sentinel lymph node biopsy in the management of patients with melanoma. Either sentinel node biopsy affords patients with the best prognostic information and biopsy followed by complete lymph node dissection provides a survival advantage for patients with intermediate thickness melanomas, or the procedures are expensive and invasive, add little or no prognostic information, and have no survival advantage. The lack of consensus is reflected in the ambiguity of guidelines internationally.1 2 3 4 5

What additional prognostic information is provided by sentinel lymph node biopsy? Many studies indicate that compared with thickness, ulceration, inflammation, or mitotic rate, sentinel lymph node status is a stronger predictor of disease-free, disease specific, or overall survival,6 but we don’t know whether sentinel lymph node status alone is a better predictor of overall survival than a combination of known prognostic indicators.7 An important confounder is that knowledge of sentinel lymph node status affects patients’ subsequent treatment. People with negative results are …

View Full Text

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial

Subscribe