The pioneering work of Morton and colleagues1 has clearly identified the value of lymphatic mapping in identifying sentinel nodes in patients with melanoma. Their work has been subsequently validated in other centers,2,3 enabling surgeons, after appropriate training, to correctly identify sentinel nodes in up to 96% of patients with melanoma. Morton et al have also shown that the use of a hand-held gamma detector facilitates identification of the sentinel node. A major international randomized trial of lymphatic mapping and selective sentinel lymphadenectomy is now in progress, and as with any new and unproven technique, it would be inappropriate to recommend its use outside a clinical trial setting until there is proof of its efficacy and reliability.
The article by Krag et al is of considerable interest, but a number of statements are made that may mislead rather than clarify the sentinel node approach. It is claimed, for example,
McCarthy WH, Thompson JF, Uren RF. Invited Commentary. Arch Surg. 1995;130(6):659-660. doi:10.1001/archsurg.1995.01430060097019