Sentinel node biopsy has no benefit for patients whose primary cutaneous melanoma has metastasized to a lymph node and therefore should be abandoned now

Sentinel Lymph Node Biopsy for Cutaneous Melanoma

“…question the theoretical basis of the procedure, suggesting that metastatic cells are not delayed for a significant duration in the sentinel node to allow for complete capture and removal via SLNB. 60,61,63 It has been debated whether the peace of mind offered by SLNB as a prognostic procedure is worth its morbidity and cost. 63 Forthcoming data from the national, multicenter trials should assist in determining the therapeutic impact of SLNB on patient outcome; in any case, careful discussion between practitioner and patient regarding the pros and cons of the SLNB procedure is of utmost importance.…”

“…[60][61][62][63] Those against the procedure emphasize the lack of randomized controlled trials that demonstrate therapeutic value alone or in combination with adjuvant medical or surgical therapy, including interferon or CLND for SLN-positive disease. [60][61][62] Some also * References 4,23,24,26,[28][29][30][31]35,36,[44][45][46][48][49][50][51]26,[29][30][31]44,45,50,52,53. ‡References 16,17,23,24,26,28,30,36,46,48,50,53.…”

Probabilistic Issues With Sentinel Lymph Nodes in Malignant Melanoma

“…Although the initial concept and the subsequent success of the sentinel node biopsy procedure was based on the logical belief that metastases in melanoma are a deterministic, stepwise process beginning with tumor in local lymphatics, proceeding to regional sentinel nodes, and eventually involving more distant sites, Bahmer 15 and Medalie and Ackerman 16 suggested there is uncertainty in each of the steps. The results of this study validate the stochastic nature of metastases in melanoma and provide formal details about the probabilistic nature of the sentinel node process.…”

“…15 In addition, Medalie and Ackerman addressed "the randomness of the process of metastasis," which they said was "manifest in the finding of metastases in some patients in whom no melanoma cells were detected in a SN [sentinel node]." 16 In this report, I address probabilistic issues for sentinel lymph node results in melanoma and provide new details about the probabilities of numbers of sentinel nodes-positive as well as total-and then address how this model relates to tumor thickness as well as to patient outcomes. …”

Impact of Sentinel Node Biopsy on Outcome in Melanoma

“…Confusion remains whether early completion lymphadenectomy imparts a survival advantage when compared directly to those patients who wait until clinically occult nodal metastatic disease becomes apparent. Some authors site compelling evidence that the assessment of the sentinel node in melanoma is of no benefit whatsoever, does not alter the course of melanoma that has metastasised and should be immediately abandoned from current practice (Medalie and Ackerman 2004). There is growing concern surrounding the reliability of the SLN to accurately predict the disease status of the entire nodal basin.…”