Sentinel Lymph Node Biopsy: Part of Melanoma Treatment's Exciting Future

Timothy M. Johnson, MD, spoke enthusiastically about the possibilities of sentinel lymph node biopsy (SLNB) in his lecture at the 25th European Academy of Dermatology and Venereology Congress in Vienna, Austria. His presentation, called “Melanoma Sentinel Node Biopsy: Past, Present and Future in the New Era of Systemic Therapies,” covered guidelines for the procedure as well as new possibilities for melanoma patients.

Johnson, who is the Lewis and Lillian Becker Professor of Dermatology at the University of Michigan, began his presentation by acknowledging that many dermatologists may not be well informed about the use of SLNB in treating melanoma, but he feels it is worth researching. “As a dermatologist, your patients will view you as their primary melanoma physician. They will look to you for guidance and counseling, including sentinel lymph node biopsy,” he said.

SLNB is a procedure in which a clinician identifies, removes, and examines the sentinel lymph node, or the lymph node to which cancer cells are most likely to spread from a tumor. Johnson explained that many patients do not fall within the guidelines to be considered for this type of biopsy, which must be performed in an operating room with general anesthesia. It is not recommended for patients with multiple comorbidities, for instance.

But for those who are eligible, he said, the procedure can have great benefit. Accuracy of tumor staging determines treatment options, and SLNB is “the gold standard test of sensitivity and specificity for staging.”

Researchers still have much to learn about SLNB, like the false negative rate and the survival subset benefit. Johnson said it was possible that if further studies of SLNB do not support its utility, it would no longer be recommended.

However, the research surrounding SLNB demonstrates that melanoma tests and treatments are in an exciting new era. The first drugs for stage IV melanoma came out only 6 years ago, and since then there has been huge growth, according to Johnson.

"This was unheard of when I started 30 years ago and it’s just, again, such an exciting time,” he said.

One of SLNB’s greatest potential uses is in determining the need for adjuvant therapy and which therapy would be most effective. Melanoma is “probably one of the hardest of all tumors to crack” because it is so heterogeneous that one single course of treatment cannot possibly work on every patient.

Johnson encouraged the audience to do their research and treat each patient as if they were a family member. Although dermatologists need to be the “lead dog” on the patient’s melanoma management team, he stressed that they “must work with other specialists collegiately, collaboratively, and humbly.”