Malignant melanoma (non-metastatic): sentinel lymph node biopsy

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Prognosis of malignant melanoma depends on depth of tumour, ulceration, mitotic rate, and number of lymph nodes involved, but also on age, sex, site of tumour, and presence of tumour-infiltrating lymphocytes. The initial diagnosis for melanoma and subsequent treatment is well established. Clinicians should follow national guidelines for the management of lesions suspected to be melanoma. Any lesions suspected of being potential melanoma should be biopsied with a narrow 2 mm margin. Once appropriate histopathological assessment has been made, a patient with a diagnosis of melanoma should be managed within the context of a multidisciplinary team and managed by clinicians who have the appropriate experience and training in the condition.

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Focus of the review

Sentinel lymph node biopsy for malignant melanoma was primarily designed as an investigative technique to ascertain whether melanoma had spread to the regional lymphatics. It remains the most reliable and effective method of enabling clinicians to stage a patient from a lymphatic perspective, and the information obtained informs decisions about the patients' most effective ongoing management. A secondary issue, as to whether there is a survival benefit for people who have had sentinel node investigation, remains controversial. We did not look at the evidence for ultrasound as RCTs are currently in progress and the results are still awaited.

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Comments on evidence

There is controversy about the benefits of sentinel lymph node biopsy with respect to improving a patient's survival. Reduction in the risk of melanoma death for patients would also appear to be a serendipitous finding, as this was not the original reason for the development of the sentinel node technique.

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Search and appraisal summary

The update literature search for this overview was carried out from the date of the last search, October 2006, to October 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 221 studies. After deduplication and removal of conference abstracts, 99 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 58 studies and the further review of 41 full publications. Of the 41 full articles evaluated, one systematic review and three RCTs were added at this update.

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Additional information

Currently, the general recommendations for a patient to qualify for consideration of a sentinel node biopsy is that they have melanoma with a histologically proven Breslow thickness of 1 mm or more; although, people with a melanoma that has a Breslow thickness greater than 0.75 mm with one or more mitoses are also considered.

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Substantive changes at this update

Sentinel lymph node biopsy One systematic review[8] and three RCTs added.[9][11][10] Categorisation unchanged (unknown effectiveness).

Abstract

INTRODUCTION: The incidence of malignant melanoma has increased over the past 25 years in the UK, but death rates have remained fairly constant. The 5-year survival rate ranges from 20% to 95%, depending on disease stage. Risks are greater in white populations and in people with higher numbers of skin naevi. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What is the evidence for performing a sentinel lymph node biopsy in people with malignant melanoma with clinically uninvolved lymph nodes? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 221 studies. After deduplication and removal of conference abstracts, 99 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 58 studies and the further review of 41 full publications. Of the 41 full articles evaluated, one systematic review and three RCTs were added at this update. We performed a GRADE evaluation for two PICO combinations. CONCLUSIONS: In this systematic overview, we evaluated the evidence for performing sentinel lymph node biopsy in people with malignant melanoma with clinically uninvolved lymph nodes.

Cite as

Pay A. Malignant melanoma (non-metastatic): sentinel lymph node biopsy. Systematic review 1705. BMJ Clinical Evidence. . 2016 January. Accessed [date].

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