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Correspondence |

Sentinel Node Biopsy: Facts to Clear the Alleged Clouds

Donald L. Morton, MD; Robert Elashoff, PhD
Arch Dermatol. 2008;144(5):685-686. doi:10.1001/archderm.144.5.685.
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Sentinel node biopsy (SNB) was developed to identify the 20% of patients with intermediate-thickness primary melanoma (1.2-3.5 mm) and regional nodal metastasis who might benefit from lymphadenectomy before, rather than after, clinical nodal recurrence.1 Our group's randomized international study of the diagnostic utility and prognostic significance of SNB2 was unjustly criticized by González.3 His commentary wrongly claims that our abstract did not include overall results. Although it is not customary to expect survival benefits for a staging and/or diagnostic procedure,4,5 we reported the overall impact of SNB on survival. Our group clearly states in the abstract2(p1307) that the mean estimated 5-year disease-free survival was 78.3% with SNB vs 73.1% with observation (hazard ratio, 0.74; P = .009). Five-year melanoma-specific survival rates were 87.1% and 86.6%, respectively.

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Figure.

Melanoma-specific survival in patients with nodal metastases. Numbers indicate subgroups. Subgroup 1 includes patients with a tumor-positive sentinel node, and subgroup 4 includes patients with nodal recurrence despite a negative finding on sentinel node biopsy. Subgroup 2 includes all patients in subgroups 1 and 4. Subgroup 3 includes patients with nodal recurrence during observation. Figure reproduced from Morton et al2 with permission.

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