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Practice Gaps
April 11, 2011

Sentinel Lymph Node Biopsy for Melanoma: One Procedure but Many Questions: Comment on “Prognostic Usefulness of Sentinel Lymph Node Biopsy for Patients Who Have Clinically Node Negative, Localized, Primary Invasive Cutaneous Melanoma”

Author Affiliations

Author Affiliations: Departments of Surgery (Drs Wong, Sabel, and Johnson) and Dermatology and Otolaryngology (Dr Johnson), University of Michigan Medical School and Comprehensive Cancer Center, Ann Arbor.

Arch Dermatol. 2011;147(4):415-416. doi:10.1001/archdermatol.2011.53

Since sentinel lymph node biopsy (SLNB) for cutaneous melanoma was developed nearly 20 years ago, there has been wide dissemination of the procedure in clinical practice, vastly changing the way patients are treated today. Although the initial Multicenter Selective Lymphadenectomy Trial,1 an international randomized clinical trial, did not clearly demonstrate a survival advantage with SLNB, the results did support its role in providing important prognostic information and improving other outcomes (eg, melanoma-specific survival rates) in patients with intermediate-thickness melanoma. The ability to accurately stage patients and offer interventions to decrease risks of regional recurrence and/or increase relapse-free survival has led to the continued use of the procedure for these patients. Ultimately, these results formed the basis of Rhodes' analysis, and he similarly concludes that SLNB provides useful information for patients with intermediate-thickness melanoma. Despite strong scientific evidence supporting SLNB for intermediate-thickness melanoma, practice gaps exist. National practice patterns show considerable variation in the use of SLNB across the United States, indicating poor dissemination of evidence and/or slow physician uptake.