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Sentinel Nodes and Interferon Alfa-2b in Melanoma: Suggested Guidelines

Sentinel node biopsy is widely used for staging and treating melanomas, and interferon alfa-2b therapy has become more readily available to physicians treating patients with tumors. Although there are many published studies of these new developments, no uniform guidelines have been developed for their use. These authors searched the literature for review articles that described the risks and benefits of each intervention. Then they convened a panel of dermatologists, medical oncologists, and surgeons with expertise in the treatment of melanoma to determine the best use of sentinel node biopsy and interferon alfa-2b therapy in 104 clinical scenarios.

The panelists found sentinel node biopsy to be appropriate for primary melanomas thicker than 1 mm and for thinner tumors that were ulcerated or Clark's level IV; it was deemed unnecessary for nonulcerated melanomas less than 0.75 mm deep. The panelists found interferon alfa-2b therapy to be indicated for patients with regional-node-based or in-transit metastases and primary melanomas thicker than 4 mm. The therapy was deemed inappropriate in patients without evidence of metastatic disease and with thinner, nonulcerated primary lesions. The panel offered other recommendations for intermediate types of lesion.

Comment: This is a very useful contribution to the literature. Although the panelists' determinations are the result of a series of educated opinions, their review of the data was quite comprehensive. They came up with a reasonable set of guidelines for the use of sentinel lymph node biopsy and interferon alfa-2b therapy. Eventually, outcome data will provide indications for using these interventions, but for now, these findings represent the best available guidance for clinicians.

— BR Smoller

Published in Journal Watch Dermatology November 6, 2001

Citation(s):

Dubois RW et al. Developing indications for the use of sentinel lymph node biopsy and adjuvant high-dose interferon alfa-2b in melanoma. Arch Dermatol 2001 Sep 137 1217-1224.

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