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What further evidence is needed to determine if a sentinel lymph node biopsy is recommended for thin melanomas?
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VernonSondakMD (Physician - Surgery - Surgical Oncology (Verified) ) - 07 / 12 / 2012
The ASCO/SSO Guidelines panel clearly got it right when the characterized the decision-making for patients with thin melanoma as balancing the staging benefits against the risks of the procedure. We’ve already said the risks of sentinel node biopsy are small (seehttp://talkabouthealth.com/what-is-the-purpose-and-goals-of-a-sentinel-lymph-node-biopsy-for-melanoma), but they are not zero. And for many patients with very thin melanomas, the risk of having a positive node is pretty close to zero – or at least way below the “false negative” rate of the procedure. Personally, I want to see at least a 5% chance that the melanoma has spread to the nodes before I think the staging benefits will outweigh the risks of the surgery. Some surgeons are more conservative – they want to see at least a 10% chance. It would be nice to have more research, including hearing directly from patients, about how they themselves see the balance between risks and benefits for the sentinel node procedure. But most importantly we need better tools to predict, for an individual patient, exactly what their risk of having a positive node really is, so we can all make more informed decisions. We’ve seen a lot of advances in our understanding of pathology prognostic factors (that is, things that can be seen in the tumor microscopically), but the next frontier is almost certainly going to be the genetic one: can we figure out which melanomas have the ‘bad’ genes that promote spread and which ones do not? If we knew that, we could probably be much more selective in our use of sentinel node biopsy, and just focus our attention on the patients with the highest risk of spread. Until that time, at a 5% positive node threshold, a lot of patients have to undergo the procedure to find just one or two who actually are found to have nodal metastasis.
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