Abstract

This controversial subject will be discussed from all aspects. Protagonists stress the staging and prognostic advantage of the procedure because sentinel node (SN)-negative patients have a significantly better prognosis than those who are SN-positive. For this reason, it is argued, SN-status is essential for entry into trials of adjuvant therapy and enables identification of patients for early lymphadenectomy with the potential for improved survival.

Detractors argue that SNB is an invasive procedure with complications and no survival advantage. They also state that ultrasound staging is as reliable and that there are procedural and statistical inaccuracies in the conduct and analysis of the relevant trials.

Patients are said to favour SNB because it offers additional prognostic information but probably hoping that their sentinel node will be negative.

Dermatologists and other health professionals sometimes feel obliged to refer patients for SNB because it is claimed by some to be “standard of care”.

These differing opinions will be discussed. Behind the headlines, there are complex issues at stake. There may even be aspects of the biology of melanoma which have not been appreciated.