Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma

Sentinel-node biopsy followed by lymphadenectomy for tumor-positive nodes improved disease-free survival among patients with intermediate-thickness melanomas (1.2 to 3.5 mm) and those with thick melanomas (>3.5 mm). Regional node management in melanoma has remained controversial since Snow 1 recommended elective complete lymphadenectomy for all patients with melanoma, regardless of whether there was clinical evidence of regional nodal metastases. However, routine elective lymphadenectomy exposes all patients to procedure-related complications and cannot benefit the majority, who have no regional nodal metastases. Multiple randomized trials have suggested a benefit of routine lymphadenectomy in at least some groups of patients with melanoma. 2 – 6 Because of dissatisfaction with both elective lymphadenectomy and nodal observation, lymphatic mapping and sentinel-node biopsy were introduced for individualized management of regional lymph nodes. 6 – 9 Sentinel-node biopsy is a . . .