According to a study published in the New England Journal of Medicine, sentinel-node biopsy provides prognostic information in patients with intermediate-thickness melanoma, and may lead to improved survival in patients who are found to have a positive sentinel node.
Melanoma is a type of skin cancer that often begins in the form of a mole. Melanoma is considered an aggressive type of cancer, which has led physicians and researchers to promote active screening measures of individuals, particularly those with light skin, moles, and/or those who have spent a lot of time in the sun. If melanoma is detected early, prior to spread, the cure rates are high. However, once melanoma has spread to distant sites in the body, long-term survival remains dismal.
Selecting the most appropriate treatment for melanoma requires accurate assessment of the extent of the cancer. Sentinel nodes are the first lymph nodes to which cancer is likely to spread. Sentinel lymph node biopsy involves the removal of these nodes. An advantage of this procedure is that if no evidence of cancer is found in the sentinel node(s), patients are considered node-negative and are spared the effects of more extensive lymph node surgery.
To evaluate patient outcomes following sentinel-node biopsy, researchers conducted a clinical trial among 1,269 patients with intermediate-thickness (1.2 to 3.5 mm) melanoma. After surgery to remove the melanoma, patients were assigned to one of two groups. One group had sentinel-node biopsy, with immediate surgery to remove more lymph nodes if the sentinel node was positive. The other group was observed and underwent lymph node surgery only after lymph nodes became enlarged.
- Sentinel-node biopsy revealed very small areas of cancer in the lymph nodes in 16% of patients. These patients had an average of 1.4 involved lymph nodes. Patients with a positive sentinel-node biopsy had worse five-year survival than patients with a negative sentinel-node biopsy (72% vs. 90%).
- 15.6% of patients in the observation group eventually had cancer detected in the lymph nodes. These patients had an average of 3.3 involved lymph nodes.
- Among patients with involved lymph nodes, survival was better among patients in the sentinel-node group than among patients in the observation group. Five-year survival was 72% among patients who had a positive sentinel-node biopsy followed immediately by more extensive lymph node surgery, and 52% among patients who had lymph node surgery only after lymph nodes became palpable.
The researchers conclude that “In patients with primary melanomas that are 1.2 to 3.5 mm in thickness, sentinel-node biopsy should be preferred to observation.”
Reference: Morton DL, Thompson JF, Cochran AJ et al. Sentinel-Node Biopsy or Nodal Observation in Melanoma. New England
Journal of Medicine. 2006;355:1307-17.
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