Sentinel lymph node biopsy for melanoma: Controversy despite widespread agreement

Although sentinel lymph node (SLN) biopsy for melanoma has been adopted thr oughout the United States and abroad as a standard method of determining th e pathologic status of the regional lymph nodes, some controversy still exi sts regarding the validity and utility of this procedure. SLN biopsy is a m inimally invasive procedure, performed on an outpatient basis at the time o f wide local excision of the melanoma, with little morbidity. Numerous stud ies have documented the accuracy of this procedure for identifying nodal me tastases. There are four major reasons to perform SLN biopsy. First, SLN bi opsy improves the accuracy of staging and provides valuable prognostic info rmation for patients and physicians to guide subsequent treatment decisions . Second, SLN biopsy facilitates early therapeutic lymph node dissection fo r those patients with nodal metastases. Third, SLN biopsy identifies patien ts who are candidates for adjuvant therapy with interferon alfa-2b. Fourth, SLN biopsy identifies homogeneous patient populations for entry onto clini cal trials of novel adjuvant therapy agents. Overall, the benefit of accura te nodal staging obtained by SLN biopsy far outweighs the risks and has imp ortant implications for patient management.