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When Melanoma Patients Should Have a Sentinel Node Biopsy

Johns Hopkins Surgery
February 1, 2014

Not every melanoma patient needs a sentinel node biopsy, says Julie Lange.

For years, oncologists have relied on sentinel lymph node biopsy to determine whether melanoma has spread to the regional lymph nodes in a newly diagnosed patient. But not every melanoma patient needs a sentinel node biopsy, says surgical oncologist Julie Lange.

"We consider the tumor thickness and other tumor characteristics," says Lange. "Patients diagnosed with a very thin melanoma generally have little chance of nearby lymph node involvement and usually do not need a sentinel node biopsy. We typically offer sentinel node biopsies to patients with a melanoma 1 millimeter or thicker, and sometimes for those with a melanoma less than 1 millimeter thick if they have certain high-risk features such as ulceration or elevated mitotic rate."

The sentinel node biopsy is a low-risk staging procedure that helps elucidate a patient's prognosis and often helps determine treatment decisions. "Most people with newly diagnosed melanoma benefit from having that information," she says.

Does Completion Dissection Result in Better Melanoma-Related Survival?

"If a biopsied node is disease-free," says Lange, "the other nodes in that basin are very likely to be free of disease as well." In cases where disease has spread to the sentinel node, however, the standard treatment has always been a completion dissection to remove the remaining nodes in that basin. "It's fairly clear that patients who have this procedure have a very low chance of recurrence in that node basin," she says. "But it remains unclear whether completion dissection results in better melanoma-related survival."

To help answer this question, Johns Hopkins is participating in an international clinical trial called the Multicenter Selective Lymphadenectomy Trial II. In this trial, more than 1,900 patients with positive sentinel lymph nodes are being randomly assigned to receive either immediate completion lymph node dissection, which is currently the standard of care, or no further surgery with ongoing ultrasound monitoring of the node basin that had the positive node. The patients will be followed for 10 years. The purpose of the study is to see whether one course of action is better than the other. "This is an important study, the result of which will help us to make the best decisions for future patients," says Lange.

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