Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

The rationale for sentinel-node biopsy in primary melanoma

Nature Clinical Practice Oncology volume 5, pages 510–511 (2008)Cite this article

Articles published in this journal have questioned the value of sentinel-node biopsy (SNB) for the management of clinically localized primary melanoma.1,2 We discuss data that support routine SNB, an approach now widely adopted worldwide. SNB is a minimally invasive staging procedure of low morbidity performed at the same time as wide excision; the first (sentinel) melanoma-draining lymph node(s) is identified for focused pathologic study.3

One in five patients with intermediate-thickness primary melanoma has metastases in regional nodes. These small tumor foci are seldom detectable by clinical or radiologic examination. Before SNB there were two management alternatives, neither of which was satisfactory. Elective, immediate, complete lymph-node dissection (CLND) exposed all patients to morbidity but could only benefit the 20% of patients with nodal metastases. Nodal observation after wide excision avoided unnecessary CLND (i.e. for patients without nodal metastases) but committed all patients to possible delayed CLND if nodal micrometastases became clinically detectable, sometimes 8–10 years later. As sentinel-node tumor status predicts nodal basin status, only patients with sentinel-node metastases need therapeutic immediate CLND; patients with tumor-negative sentinel nodes require no further nodal surgery, have prolonged survival4 and require fewer follow-up visits.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Thomas JM (2008) Prognostic false-positivity of the sentinel node in melanoma. Nat Clin Pract Oncol 5: 18–23

    Article  Google Scholar 

  2. Rosenberg SA (2008) Why perform sentinel-lymph-node biopsy in patients with melanoma? Nat Clin Pract Oncol 5: 1

    Article  Google Scholar 

  3. Morton DL et al. (2005) Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg 242: 302–311

    PubMed  PubMed Central  Google Scholar 

  4. Morton DL et al. (2006) Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 355: 1307–1317

    Article  CAS  Google Scholar 

  5. Morton DL and the MSLT-II Trials Group. Interim update of MSLT-I and MSLT-II. Sixth Biennial International Sentinel Node Society Meeting, Sydney, Australia, 18–20 February 2008

  6. Balch CM et al. (2001) Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system. J Clin Oncol 19: 3622–3634

    Article  CAS  Google Scholar 

  7. Morton DL et al. (2007) Sentinel-node biopsy in melanoma. N Engl J Med 356: 419–420

    CAS  Google Scholar 

  8. Morton DL et al. (2007) Can completion lymph node dissection be avoided for a positive sentinel node in melanoma? Ann Surg Oncol 14: 2437–2439

    Article  Google Scholar 

  9. Balch CM and Cascinelli N (2007) Sentinel-node biopsy in melanoma. N Engl J Med 356: 420–421

    CAS  Google Scholar 

  10. Sabel MS et al. (2007) Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy. Surgery 141: 728–735

    Article  Google Scholar 

  11. Starritt EC et al. (2005) Ultrasound examination of sentinel nodes in the initial assessment of patients with primary cutaneous melanoma. Ann Surg Oncol 12: 18–23

    Article  Google Scholar 

  12. Wen D-R. et al. (2008) Tumor burden and outcome. Sixth Biennial International Sentinel Node Society Meeting, Sydney, Australia, 18–20 February 2008

  13. Scheri RP et al. (2007) Isolated tumor cells in the sentinel node affect long-term prognosis of patients with melanoma. Ann Surg Oncol 14: 2861–2866

    Article  Google Scholar 

Download references

Acknowledgements

The Multicenter Selective Lymphadenectomy Trials (MSLT-I and MSLT-II) mentioned in this report are supported by funding from the National Cancer Institute (CA29605).

Author information

Authors and Affiliations

  1. DL Morton is Chief of the Melanoma Program and Director of the Surgical Oncology Fellowship Program at the John Wayne Cancer Institute, Saint John's Health Center, California, and Professor of Surgery Emeritus of the University of California at Los Angeles School of Medicine. AJ Cochran is Distinguished Professor of Pathology and Laboratory Medicine and Surgery, at the University of California at Los Angeles School of Medicine, USA.,

    Donald L Morton & Alistair J Cochran

  2. JF Thompson is Director of The Sydney Melanoma Unit and Professor of Surgery (Melanoma and Surgical Oncology) at the University of Sydney, Australia.,

    John F Thompson

Authors
  1. Donald L Morton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alistair J Cochran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John F Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donald L Morton.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morton, D., Cochran, A. & Thompson, J. The rationale for sentinel-node biopsy in primary melanoma. Nat Rev Clin Oncol 5, 510–511 (2008). https://doi.org/10.1038/ncponc1205

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncponc1205

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing