A recent gloomy personal opinion expressed by Kanzler1 contains errors, lacks balance, and is impatiently premature. Sentinel node (SN) biopsy (SNB) is “highly controversial” only for an outspoken minority who stubbornly ignore published data. Patients are best served by even-handed consideration of emerging data on melanoma management.
Twenty percent of patients with intermediate-thickness melanoma ostensibly confined to the primary site develop regional nodal metastases after wide excision. Our research group developed SNB to identify those individuals and demonstrated the accuracy and practicability of lymphoscintigraphy and dye-based lymphatic mapping for pinpointing initial nodes on the lymphatic pathway draining the primary melanoma.2 Careful histologic and immunohistologic analysis demonstrates melanoma in approximately 20% of sentinel nodes (SNs). Unlike evaluation of the primary tumor, evaluation of the SNs identifies the presence rather than the probability of nodal metastases.