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Sentinel node biopsy needs for a suitable therapeutic management of the cutaneous melanoma

Nature Clinical Practice Oncology volume 6, page E1 (2009)Cite this article

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Arising from: Thomas JM (2008) Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol 5: 18–23 doi: 10.1038/ncponc1014

Sentinel node biopsy (SNB) has become the standard procedure following the excision of primary melanoma tumors with a Breslow's thickness ≥ 1 mm or IV/V Clark's level. To date, there is agreement that this minimal invasive surgery alone has no impact on overall survival. In a randomized study, Morton et al. stated that no survival benefit was associated with SNB compared with observation,1 but despite this finding the authors concluded that SNB should be preferred to observation. On the basis of these conclusions, Rosenberg commented that although SNB provides prognostic information it is an expensive procedure with associated morbidity.2 Ross et al. reported the results of the Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) that demonstrated a non-significant survival advantage for patients in the SNB group at a median follow-up of 5 years. However, the authors noted that SN-positive patients who underwent immediate lymphadenectomy (selective lymphadenectomy) had a significant (20%) survival advantage compared with those in the observation group who subsequently developed palpable nodal disease,3 similarly to the results (P = 0.04) in World Health Organization's randomized trial.4 These data demonstrate that SN micrometastasis detected only by immunohistochemistry can become macrometastasis when detected by routine histopathology with greater probability of systemic dissemination and worse prognosis,5 in addition to the possibility of 'false positivity' as noted by Thomas.6 Early surgical and medical treatment of nodal disease could favourably alter the natural history of melanoma.

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Authors and Affiliations

  1. Department of Surgical Sciences - CIC, Catholic University of Sacred Heart, G. Moscati Street, Rome, 31 – 00168, Italy

    Ettore Minutilli, Uwe Trefzer, Eggert Stockfleth & Wolfram Sterry

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  1. Ettore Minutilli
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  2. Uwe Trefzer
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  3. Eggert Stockfleth
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  4. Wolfram Sterry
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Correspondence to Ettore Minutilli.

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The authors declare no competing financial interests.

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Minutilli, E., Trefzer, U., Stockfleth, E. et al. Sentinel node biopsy needs for a suitable therapeutic management of the cutaneous melanoma. Nat Rev Clin Oncol 6, E1 (2009). https://doi.org/10.1038/ncponc1302

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