Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Department of Dermatology, Venerology, and Allergology (Drs Stoffels and Klode) (email@example.com), Institute for Medical Informatics, Biometry, and Epidemiology (Dr Scherag), University of Duisburg-Essen, Essen, Germany.
In Reply: As pointed out in our article, there are limitations resulting from the study design. In addition to general concerns related to observational studies, Drs Dupuy and Heusse highlight the biases that may result from the temporal separation of the 2 cohorts, suggesting as an example a change in the surgical team by including an experienced surgeon during the later period. As described in the article, the same surgical technique was used in both cohorts.
Stoffels I, Scherag A, Klode J. SPECT/CT for Sentinel Lymph Node Detection in Patients With Melanoma—Reply. JAMA. 2013;309(3):232-233. doi:10.1001/jama.2012.88573