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February 2004

Sentinel Lymph Node Biopsy in Patients With Thin Melanoma—Reply

Arch Dermatol. 2004;140(2):237-239. doi:10.1001/archderm.140.2.238

In reply

We agree with the comments provided by Dr Bahmer regarding the application of appropriate and exact tissue sectioning and sampling of SLNs for melanoma micrometastasis, and appreciate the references provided. Our present method of sentinel node evaluation consists of bisecting the sentinel node in the plane of the hilum, serially sectioning and submitted in entirety. Twenty-two serial slides are cut at 3 to 4 µm, and hematoxylin-eosin stains are performed on slides 1, 10, and 20. If these are negative, immunoperoxidase stains for Melan-A are obtained on slides 2, 11, and 21. As to Dr Bahmer's point, the sectioning and stains are always performed in the same order. In our retrospective study that included 46 patients, approximately 50% of our cases were evaluated by this method, and 50% by hematoxylin-eosin alone (standard procedure prior to the year 2000). Interestingly, of the 3 patients whose specimens had evidence of metastasis, 2 were determined by hematoxylin-eosin alone.