The argument against sentinel node biopsy for malignant melanoma

Its use should be confined to patients in clinical trials

Sentinel node biopsy has been enthusiastically adopted into clinical practice without a clear understanding of its benefit, which is often assumed rather than proved. Recently, the status of the sentinel node has been shown to be the most important predictor of recurrence and survival for patients with malignant melanoma. The proportion of patients who have had a negative sentinel node biopsy and who are free of disease at three years is 88.5% compared with 55.8% of patients with a positive biopsy; these groups have overall survival rates of 93% and 67%, respectively.1 2

The thickness of the tumour and whether there is ulceration remain important prognostic discriminators in patients with a negative biopsy.1 But is the ability to stratify patients prognostically enough to justify the widespread use of sentinel node biopsy or should we wait for evidence of a survival benefit after selective node dissection in patients who have had a positive sentinel node on biopsy?

Several reasons have been given to justify the use of sentinel node biopsy. Firstly, it is cheaper and causes less morbidity than elective lymph node dissection. The total cost per patient, including the cost of wide local excision, is $19 285 (£12 856) for elective lymph node dissection compared with $13 835 for sentinel node biopsy under …