SLNB guidelines target melanoma staging

Hi all

This came out this week. This is pretty vague about changing prognosis and I will go back to the source

Ian

SLNB guidelines target melanoma staging

National report — Two oncology societies have teamed to issue their first evidence-based clinical practice guidelines for using sentinel lymph node biopsy (SLNB) to stage patients with newly diagnosed melanoma.

The American Society of Clinical Oncology and the Society for Surgical Oncology noted that recent studies suggest SLNB is used inconsistently, according to a news release. The guideline recommendations are based on a review of all available evidence and are meant to clarify which patients should receive the procedure.

The guideline recommendations are:

  • SLNB is recommended for all patients with melanoma tumors of intermediate thickness (between 1 and 4 mm). Studies have shown that the technique is useful for identifying small nearby metastases in these patients, who account for about one-third of all melanoma cases.
  • Evidence is insufficient to recommend routine SLNB for patients with melanoma tumors less than 1 mm. Thin melanomas are the most common form of melanoma and can usually be cured through surgical removal of the primary tumor.
  • SLNB for patients with thick melanoma tumors (greater than 4 mm) may be recommended. Thick melanomas are more uncommon than the above two types, but are considered more likely to spread.
  • Completion lymph node dissection is recommended for all patients with a positive SLNB. Complete removal of the remaining lymph nodes has been shown to prevent or limit further cancer spread in these patients.

The authors recommended clinicians discuss SLNB as part of a comprehensive treatment planning process with their melanoma patients.

The guidelines were published in Annals of Surgical Oncology.

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  1. #1 by Graeme Siggs on July 12, 2012 - 8:29 am

    SLNB is an invasive investigation not a treatment. Some authors seem to get this confused.
    SLNB status is the most important predictor of prognosis, even more powerful than Breslow thickness, mitotic rate and ulceration.
    There is no denying that SLNB positive patients have a worse prognosis than SLNB negative patients.
    Immediate CLND for SLNB positive patients (the treatment) has not yet been shown to improve disease-specific survival in melanoma (MSLT-I), although it may improve loco-regional recurrence.
    MSLT-II will hopefully clarify these issues.
    There is understandable controversy about whether SLNB and immediate CLND should be current ‘standard of care’ when evidence is lacking. This may explain why SLNB is used ‘inconsistently’.

    This was also reported here:
    http://medconnect.com.au/tabid/311/ct1/c346186/ASCO-SSO-Back-Sentinel-Lymph-Node-Biopsy-in-Melanoma-/Default.aspx?nomobile=1

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