ABSTRACT
Reliable staging of patients with melanoma using the technique of selective sentinel lymphnode biopsy requires that each sentinel lymph node (SLN) must be correctly identified and removed.1,2 It is not sufficient to identify and remove a single SLN in a lymph-node field if more than one SLN is present in that field. Similarly, staging may be inaccurate if an SLN is present outside a recognized lymph-node field (e.g., as an interval node between the primary melanoma site and the expected drainage field) and is not identified and removed for histologic examination.3 It goes without saying that unless staging by selective SLN biopsy is completely accurate, the information obtained will be misleading, and inappropriate management decisions may be made as a result. The greatest risk is that a positive SLN will be missed. In this situation, one of two things will happen: either clinical evidence of melanoma recurrence will become apparent at a later time,
when the likelihood of successful curative treatment will be lower; or in the future, the indication for treatment with an adjuvant therapy of proven efficacy will not be recognized. The other important problem that will arise if SLN biopsy provides information that is incorrect or incomplete involves patients entering randomized trials of adjuvant therapy and being incorrectly staged. This situation increases the difficulty of interpreting the results of such trials.
