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Sentinel lymph node biopsy for melanoma: an important risk-stratification tool

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To the Editor: The article by Gyorki and Henderson1 is misleading and inaccurate. The stated primary outcome of the Multicenter Selective Lymphadenectomy Trial-1 (MSLT-1) was:

To determine whether wide excision of the primary with intraoperative lymphatic mapping (LM) followed by selective lymphadenectomy will effectively prolong overall survival compared to wide excision of the primary melanoma alone.2

It was prolongation of overall survival, and not disease-specific survival as the authors state.1

The MSLT-1 final report3 is an example of selective reporting bias, and failed to prove its primary outcome. The conclusions based on the post-hoc analysis are unreliable, and should never be used to guide management decisions, yet the MSLT-1 trial reporting focused almost exclusively on these results.

The other claimed benefit by the authors of MSLT-1, disease-free survival, is an illusion and has been rejected on several grounds, lead-time bias being a chief one.4

Lymph node status may not be the strongest predictor of survival for patients with intermediate thickness melanoma. Indeed, combining clinicopathological features (thickness, mitotic count, ulceration,…