BMJ Raises Concerns Over The Effectiveness Of A Invasive And Costly Procedure For Melanoma

Melanoma is the fifth most common malignancy in the UK, influencing one in 60 people. In the US it affects one in 50 people and, of the seven most common cancers, is the only one that are increasing. Sentinel node biopsy was developed in the US in the early 1990s to detect the early spread of cancers cells in patients with melanoma.

It involves taking a little sample of the lymph node (gland) nearest to the melanoma for assessment. If cancer cells are found, patients should have surgery to remove some of the encompassing lymph nodes. The results proved controversial, but further analyses of the data (expected around 2008 and 2011) that would have resolved the question of efficiency once and for all have never yet been published. So when the BMJ contacted the lead researcher, he offered no timescale for when the publication of the results could be expected.

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Meanwhile, large numbers of patients are exposure to unnecessary and harmful surgery potentially. It really is thought that as much as 96% of patients who’ve sentinel node biopsy will have unnecessary surgery, which assesses the risk of problems such as lymphoedema (severe engorgement of the limbs), cellulitis (deep skin infection) and scarring. In England, the guidance from the National Institute for Health insurance and Clinical Excellence (NICE) declares that sentinel node biopsy should be performed only in centers with experience in the context of clinical tests.

The figures also claim that in 2010-11, over 1,100 sentinel node biopsies might have been conducted at an estimated cost to the NHS of £7.6m. Given only two studies of sentinel node biopsy in melanoma are ongoing, this will probably account for only a small percentage of these biopsies. Commenting on the report, BMJ Editor Dr Fiona Godlee, says the data that much research goes unreported is overpowering, putting patients in danger, and wasting health care resources.

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