Sentinel node biopsy increases survival rates in melanoma patients

Moffitt Cancer Center researchers have been instrumental in making significant improvements to the diagnostic procedure called sentinel node biopsy for melanoma patients and teaching this procedure to physicians from around the world.

Sentinel nodes are the first lymph nodes to which cancer cells from a primary tumor like melanoma will spread. In the sentinel node biopsy procedure, a radioactive tracer and a blue-colored dye are injected at or near the melanoma site on the skin and tracked to the first lymph node(s). These sentinel nodes are then surgically removed and analyzed for the presence of cancer cells. If tumor cells are present within the node, the primary tumor has spread and additional lymph nodes may need to be removed and medical treatments tailored accordingly. If tumor cells are not present in the sentinel node, the primary tumor most likely has not spread to lymph nodes or other organs.

Sentinel node biopsy reduces the possibility of patients having to undergo extensive lymph node surgery and its associated side effects such as tissue swelling, lymph accumulation at the surgery site, pain, discomfort, and overall decreased quality of life.

"Moffitt played a pioneering role in the development, testing and teaching of sentinel node biopsy, after the procedure was introduced in 1992," said Vernon K. Sondak, M.D., chair of Moffitt's Department of Cutaneous Oncology. "Now, this procedure has become a worldwide standard."

The final results of the Multicenter Selective Lymphadenectomy Trial (MSLT-1) that began in 1994 to assess the benefits of sentinel node biopsy for melanoma patients were recently published in the New England Journal of Medicine (NEJM). Moffitt's Christopher A. Puleo, PA-C, was one of the contributors to the study and is a co-author of the publication.

The article reports data from a 10-year follow-up of 2001 melanoma patients from the landmark MSLT-1 study; preliminary data were first published in the NEJM in 2006. Patients who had sentinel node biopsies had significantly greater 10-year disease-free survival rates than patients who underwent nodal observation. Node-positive patients also had improved 10-year rates of survival without metastasis and melanoma-free survival compared to those whose nodes were found to be positive on the nodal observation arm of the study.