Underuse of sentinel lymph node biopsy for early-stage melanoma

To the Editor: Sentinel lymph node biopsy (SLNB) plays a crucial role in the prognostication of cutaneous melanoma. Current guidelines by the National Comprehensive Cancer Network recommend offering SLNB to patients with intermediate-thickness melanoma (stage IB to IIC). 1 Swetter S.M. Thompson J.A. Albertini M.R. et al. NCCN Guidelines® insights: melanoma: cutaneous, version 2.2021: featured updates to the NCCN guidelines. J Natl Compr Cancer Netw. 2021; 19: 364-376https://doi.org/10.6004/jnccn.2021.0018 Crossref PubMed Scopus (105) Google Scholar While the landmark MSLT-I trial 2 Morton D.L. Thompson J.F. Cochran A.J. et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014; 370: 599-609https://doi.org/10.1056/NEJMoa1310460 Crossref PubMed Scopus (1070) Google Scholar demonstrated no survival benefits to SLNB, later studies have concluded the opposite. 3 Roumen R.M.H. Schuurman M.S. Aarts M.J. Maaskant-Braat A.J.G. Vreugdenhil G. Louwman W.J. Survival of sentinel node biopsy versus observation in intermediate-thickness melanoma: a Dutch population-based study. PLoS One. 2021; 16e0252021https://doi.org/10.1371/journal.pone.0252021 Crossref Scopus (5) Google Scholar ,4 Knackstedt T. Differences in sentinel lymph node biopsy utilization in eligible melanoma patients treated with Mohs micrographic surgery or wide local excision: a population-based logistic regression model and survival analysis. J Am Acad Dermatol. 2023; 88: 848-855https://doi.org/10.1016/j.jaad.2022.11.004 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar SLNB also carries defined surgical morbidity. Therefore, the value of lymphatic mapping for any given patient remains a topic of controversy. In this multi-institutional retrospective study, we sought to identify factors associated with SLNB noncompletion, the documented rationales in clinical practice, and impact on survival.