Developing Indications for the Use of Sentinel Lymph Node Biopsy and Adjuvant High-Dose Interferon Alfa-2b in Melanoma

Examining the Utility of Performing Sentinel Node Biopsies for T1 Melanomas with Breslow Depths between 0.75 and 1.0 mm: A Review of a 20 Year Experience

“…The data from this study further suggests that sentinel lymph node biopsies should be performed for melanomas with Breslow depths between 0.75 and 1.0 mm, if a Clark's level IV or greater, confirming previous reports [30][31][32]. …”

“…Although the pathology reports did not uniformly provide Clark's level as well as Breslow depth, the two positive sentinel nodes were from melanomas with advanced Clark's levels of IV and V (Table 1), whereas only 35% of the negative node melanomas had levels of ulceration this advanced (Table 2). This finding further substantiates the recommendation that SLN biopsies be performed for thin melanomas with Clark's level of IV or greater [30][31][32].…”

“…It is speculated that early identification may confer a therapeutic and survival advantage, although this has not been proven [26][27][28][29]. Nonetheless, most physicians offer SLN mapping to patients with thin melanoma (1 mm or less) if it is a Clark's level IV lesion or deeper [30]. This recommendation is based on data to suggest that in patients with otherwise favorable melanoma based on Breslow depth (0.76 mm or less), Clark's level IV, and severe histologic regression are independently predictive of mortality from recurrent disease [31].…”

Severe Raynaud Syndrome Induced by Adjuvant Interferon Alfa in Metastatic Melanoma

“…Interferon alfa is a biologic response modifier and the best agent for adjuvant treatment of patients with melanoma in stages ii and iii, improving relapsefree and overall survival 1 . Its immunomodulating, anti-proliferative, and antiviral properties have also proved therapeutic for viral hepatitis, hematologic malignancies, and solid and vascular tumours.…”

A critical assessment of treatment options for idiopathic pulmonary fibrosis

“…When definitive evidence is lacking, the RAND/UCLA consensus panel method has been shown to provide the most up-to-date guidance, combining an evidence-based review with the practical experience of clinician-leaders in the field. This method has been used for diverse topics, including treatment of depression in women, sentinel lymph node biopsy in melanoma, use of NSAIDs/ Cox-2 inhibitors with proton-pump inhibitors, and appropriateness of surgery for sciatica [3][4][5][6]. It is with this background that we report the opinions of a group of highly selected IPF experts.…”