Sentinel node biopsy for malignant melanomaBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7271.1285 (Published 18 November 2000) Cite this as: BMJ 2000;321:1285
Having this biopsy gives psychological benefits
- S S Rayatt (firstname.lastname@example.org), specialist registrar in plastic surgery,
- S P Hettiaratchy, specialist registrar in plastic surgery
- Department of Plastic Surgery, Sandwell Healthcare NHS Trust, West Bromwich, West Midlands B71 4HJ
- Department of Plastic Surgery, Selly Oak Hospital, Birmingham B29 6JD
- West Bar Surgery, Banbury OX16 9SF
- Melanoma Unit, St George's Hospital, London SW17 0QT
- Department of Plastic and Reconstructive Surgery, Radcliffe Infirmary, Oxford OX2 6HE
- St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH
- St Thomas's Hospital, London SE1 7EH
- Royal Free Hospital, London NW3 2PF
- Department of Dermatology, Hammersmith Hospital, London W12 0NN
- Melanoma and Sarcoma Unit, Royal Marsden Hospital, London SW3 6JJ
EDITOR—The editorial by Thomas and Patocskai summarises the current state of sentinel lymph node biopsy for malignant melanoma.1 What the authors omitted to address was patients' perception of the procedure.
Anecdotal evidence suggests that patients with melanoma derive psychological benefit from having the procedure, regardless of the result. To investigate any such benefit our unit carried out a study looking at the acceptability and benefits of the procedure. A specially designed questionnaire was sent to 110 patients who had undergone the procedure between August 1997 and February 1999.
Ninety eight patients (89%) replied, including all those in whom the result had been positive (19/110). To study any time dependent trends the respondents were subdivided into three subgroups, depending on length of follow up (table). Most patients (95/98) were glad that they had had the procedure, though the effects decreased with time (table). Overall 89 of the patients believed that they had gained some benefit from the biopsy, and 96 said that they would recommend it to other patients.
Most patients with melanoma undoubtedly derive at least short term psychological benefits from having a sentinel lymph node biopsy. This effect seems to be independent of the result of the biopsy itself. The decreased reassurance with time may simply represent a time dependent factor but might be due to the frequent clinic visits and additional biopsies of suspicious lesions, which cause increased anxiety in patients with melanoma.2
The procedure has high patient acceptability and offers patients a proactive option in addition to regular clinic reviews after initial diagnosis. It does not, however, seem greatly to influence patients' worries about being “cured” or fully enable patients to plan for the future. The small psychological …