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Reply to Shaw and Thompson: "Frequency of Nonsentinel Lymph Node Metastasis in Melanoma"

Division of Surgical Oncology, University of Louisville, James Graham Brown Cancer Center, Louisville, Kentucky

To the Editor:

When nodal metastasis is identified in melanoma patients by sentinel lymph node (SLN) biopsy, it is usually a small microscopic focus of tumor in a single SLN. Completion lymphadenectomy for a positive SLN most often results in a lymph node dissection specimen bearing no further evidence of metastatic disease. This experience has prompted many surgeons to question the necessity of routine completion lymphadenectomy when metastatic disease is identified in the SLN. Some have suggested that patients with more favorable primary melanomas may have such a low risk of nonsentinel node (NSLN) metastasis that completion lymphadenectomy can be avoided. The experience from the multi-institutional Sunbelt Melanoma Trial indicated that we could not identify any population of patients with positive SLN that had a minimal risk of NSLN metastasis.¹ The analysis from the Sydney Melanoma Unit provides definitive confirmatory evidence from the world’s largest and most experienced melanoma center. In fact, the single institution data presented by Drs. Shaw and Thompson are strikingly similar to the data from the multi-institutional Sunbelt Melanoma Trial. It is refreshing to see that the robust technique of SLN biopsy, developed by Dr. Donald Morton over a decade ago, can provide reproducible results from not only the world’s most renowned melanoma unit but from 46 centers across North America. Therefore, I believe we are in agreement that routine completion lymphadenectomy should be performed whenever metastatic disease is identified in the SLN.

REFERENCES

1. McMasters KM, Wong SL, Edwards MJ, et al. Frequency of nonsentinel lymph node metastasis in melanoma. Ann Surg Oncol 2002; 9: 137–41[Abstract/Free Full Text]

This article has been cited by other articles:

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				D. G. Coit In Reply Ann. Surg. Oncol., October 1, 2003; 10(8): 993 - 994. [Full Text] [PDF]

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