Need for Consensus on Sentinel Node Biopsy

March 24, 2015

Editorial Excerpts

In this edition of the British Journal of Dermatology we see stark evidence of the polarization that bedevils the state of sentinel node biopsy (SNB) in melanoma [1][2]. Couple this with a fact almost universally acknowledged, that doctors are confused by statistics, and it is little wonder that we find it difficult to help patients make informed decisions about their treatment.

The 10-year analysis of SNB data from Multicenter Selective Lymphadenectomy Trial (MSLT)-I are now available, and it is time to reach consensus in management. Melanoma is a dangerous disease and patients deserve better than to have their management determined by personal conviction or possible gain, or informed by spin. Sladden et al. claim the evidence does not justify SNB as the gold standard of care, while Faries et al. (for the MSLT group) tell us that 'failure to recommend this technique […] raises important ethical questions that cannot be ignored.'

There are four main controversies surrounding the MSLT-1 data: the conflation of SNB staging with perceived benefit to patients; the claimed survival benefit of intervention (SNB) over observation in those with nodal metastases; the possibility of overdiagnosing nodal micrometastases (nodes that contain melanoma cells but that would not have progressed even if the node had not been removed); and finally the claim that intervention significantly improves disease-free survival.

Source:

McGregor JM and Sasieni P. Sentinel node biopsy in cutaneous melanoma: time for consensus to better inform patient choice. British Journal of Dermatology 172:3;552–554, March 2015. [Full free-to-access editorial available at: http://onlinelibrary.wiley.com/doi/10.1111/bjd.13666/full ]

Articles to which editorial refers:

[1] Sladden M, et al. No survival benefit for patients with melanoma undergoing sentinel lymph node biopsy: critical appraisal of the Multicenter Selective Lymphadenectomy Trial-I final report. British Journal of Dermatology 172:3;566-571, March 2015. http://onlinelibrary.wiley.com/doi/10.1111/bjd.13675/abstract

[2] Faries MB, et al. Multicenter Selective Lymphadenectomy Trial-I confirms the central role of sentinel node biopsy in contemporary melanoma management. Response to 'No survival benefit for patients with melanoma undergoing sentinel lymph node biopsy: critical appraisal of the Multicenter Selective Lymphadenectomy Trial-I final report'. British Journal of Dermatology. 172:3;571-573, March 2015. http://onlinelibrary.wiley.com/doi/10.1111/bjd.13676/abstract