In reply: The role of sentinel lymph node biopsy after excision of melanomas

In Reply: Thank you for your important question. Examination of the excision specimen of the patient’s primary cutaneous melanoma lesion demonstrated a Breslow depth of 1.92 mm. He did indeed undergo sentinel lymph node biopsy at the time of excision. Histologic examination of the biopsy specimen was negative for evidence of metastatic melanoma. Despite this, he obviously developed metastatic disease several years later.

As you allude to, sentinel lymph node biopsy is an important minimally invasive procedure in patients with melanoma. Morton et al¹ compared it with nodal observation and found that in patients with at least intermediate-thickness cutaneous melanoma, sentinel node biopsy significantly prolonged disease-free survival for all patients and improved melanoma-specific survival rates for patients with nodal metastases from intermediate-thickness melanomas (1.2–3.5 mm).¹ However, it remains an imperfect procedure, and a percentage of patients develop recurrence or metastasis despite a negative biopsy. In a recent study by Jones et al,² 16% of melanoma patients in a cohort with a negative sentinel node biopsy developed recurrence.² In these unfortunate patients, medications such as CTLA-4 inhibitors and PD-1 inhibitors now offer hope for prolonged survival.

In Reply: Thank you for your important question. Examination of the excision specimen of the patient’s primary cutaneous melanoma lesion demonstrated a Breslow depth of 1.92 mm. He did indeed undergo sentinel lymph node biopsy at the time of excision. Histologic examination of the biopsy specimen was negative for evidence of metastatic melanoma. Despite this, he obviously developed metastatic disease several years later.

As you allude to, sentinel lymph node biopsy is an important minimally invasive procedure in patients with melanoma. Morton et al¹ compared it with nodal observation and found that in patients with at least intermediate-thickness cutaneous melanoma, sentinel node biopsy significantly prolonged disease-free survival for all patients and improved melanoma-specific survival rates for patients with nodal metastases from intermediate-thickness melanomas (1.2–3.5 mm).¹ However, it remains an imperfect procedure, and a percentage of patients develop recurrence or metastasis despite a negative biopsy. In a recent study by Jones et al,² 16% of melanoma patients in a cohort with a negative sentinel node biopsy developed recurrence.² In these unfortunate patients, medications such as CTLA-4 inhibitors and PD-1 inhibitors now offer hope for prolonged survival.

In Reply: Thank you for your important question. Examination of the excision specimen of the patient’s primary cutaneous melanoma lesion demonstrated a Breslow depth of 1.92 mm. He did indeed undergo sentinel lymph node biopsy at the time of excision. Histologic examination of the biopsy specimen was negative for evidence of metastatic melanoma. Despite this, he obviously developed metastatic disease several years later.

As you allude to, sentinel lymph node biopsy is an important minimally invasive procedure in patients with melanoma. Morton et al¹ compared it with nodal observation and found that in patients with at least intermediate-thickness cutaneous melanoma, sentinel node biopsy significantly prolonged disease-free survival for all patients and improved melanoma-specific survival rates for patients with nodal metastases from intermediate-thickness melanomas (1.2–3.5 mm).¹ However, it remains an imperfect procedure, and a percentage of patients develop recurrence or metastasis despite a negative biopsy. In a recent study by Jones et al,² 16% of melanoma patients in a cohort with a negative sentinel node biopsy developed recurrence.² In these unfortunate patients, medications such as CTLA-4 inhibitors and PD-1 inhibitors now offer hope for prolonged survival.