JAMA Internal Medicine: Melanoma Topic Collection

Sentinel Lymph Node Biopsy in Early Melanoma Comment on “What the Surgeon Should Have Said to My Patient With Thin Malignant Melanoma” Sentinel Lymph Node Biopsy in Early Melanoma

Linos E. — Mon, 25 Jun 2012 00:00:00 GMT

Sentinel node biopsy may be a useful prognostic tool for a subset of melanomas of intermediate stage. The Perspective by Benjamin and Froom, however, highlights the problems with its use in a different situation: a patient with an early stage IA melanoma, 0.5 mm in depth, without ulceration or a high mitotic rate. This patient has an excellent prognosis, with a 98% expected survival at 15 years and a greater than 97% chance of having clear lymph nodes.

What the Surgeon Should Have Said to My Patient With Thin Malignant Melanoma What the Surgeon Should Have Said

Benjamin MF, Froom P. — Mon, 25 Jun 2012 00:00:00 GMT

A 46-year-old man incidentally discovered a pigmented lesion near the medial edge of his right scapula. There were no palpable lymph nodes. The biopsy revealed a malignant melanoma with favorable prognostic indicators: 0.5 mm deep, with focal infiltration of the papillary dermis; less than 1 mitosis per mm²; no ulceration; and areas with reactive lymphocytic and plasma cell infiltration (99% chance of 10-year survival). A renowned surgical oncologist recommended wide excision with sentinel lymph node biopsy, saying,