We thank Rebora for his comments on a possible relationship between surgical intervention, stimulation of lymphangiogenesis, and promotion of metastasis. Rebora posits that surgery itself might promote lymphangiogenesis, although he does not specify which procedure (biopsy, wide local excision, or sentinel node biopsy) might be more likely to place the patient at risk for lymphangiogenesis and subsequent possible metastasis. Indeed, the initial biopsy procedure, when the tumor is removed from the patient, would seem at least as likely to generate lymphangiogenic factors of relevance as the subsequent wide excision of surrounding normal tissue. However, he correctly acknowledges that biopsy is necessary to confirm the diagnosis of melanoma. Furthermore, there is no reason to consider abandoning wide local excision with its attendant reduction in risk of local recurrence, and fears that sentinel lymph node biopsy could increase lymphatic metastasis have proven completely unfounded.1,2
Messina JL, Sondak VK. Lymphangiogenesis Induced by Surgery: A Risk for Melanoma Metastasis—Reply. Arch Dermatol. 2009;145(1):90. doi:10.1001/archdermatol.2008.534
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