The growing incidence of cutaneous melanoma, in its three most common variants–Superficial Spreading Melanoma (SSM), Lentigo Maligna Melanoma (LMM) and Nodular Melanoma (NM) – is a well-known fact that is of concern to the scientific community and, increasingly, to the public in general. An annual increase of 5%, as the authors point out, is a very worrying figure.

Under these circumstances, it is very important to contrast the validity and efficiency of these new methods for the early detection of metastases, and their prognostic value. The Sentinel Node Biopsy (SNB) is a technique that has been verified but it is not free of controversy.

The authors have carried out a rigorous work from the methodical point of view and they have made a noteworthy contribution to the study of metastases in head and neck cutaneous melanoma. Nevertheless, it is a retrospective study with a reduced sample, which rather limits the significance of the conclusions drawn. What stands out in addition to this, is the length of the interval between the diagnosis and carrying out the SNB, which is 50.4 days and 90 days on some occasions. The authors also carried out a widening of the surgical margins of the primary tumor in 10 of the 12 cases without revealing the motive. Both things together could have contributed to a modification of the results. On the other hand, the criteria for choosing patients depending on whether the tumor thickness is 1 mm or above, or less than 1 mm but ulcerated, does not seem to be reliable. Mac- Neill et al¹ have published cases of tumors with a thickness of less than 1 mm, that were not ulcerated and that had lymphatic metastases confirmed by SNB. The incidence of metastatic nodes is low compared with other authors (Mac- Neill et al¹, Maccauro et al²), but it tallies with those of Carlson et al (17,6%).³

As stated in the article, the sensitivity of the technique is high – 91.6% and even 100%1 in some series. It could be a useful technique for its prognostic value, but survival does not improve and it is not free of complications. The possibility of errors can also increase as a result of the frozen samples being unreliable.

Gabriel Forteza González
Servicio de Cirugía Oral y Maxilofacial
Hospital Joan XXIII, Tarragona. España

1. MacNeill KN, Ghazarian D, McCready D, Rotstein L. Sentinel lymph node biopsy for cutaneous melanoma of the head and neck. Ann Surg Oncol 2005;12:726-32.

2. Maccauro M, Villano C, Aliberti G, Ferrari L, Castellani MR, Patuzzo R, Tshering D, Santinami M, Bombardieri E. Lymphoscintigraphy with intraoperative gamma probe sentinel node detection: clinical impact in patients with head and neck melanomas. Q J Nucl Med Mol Imaging 2005;49:245-51.

3. Carlson GW,Murray Dl, Lyles RH, Hestley A, Cohen. Lymph node biopsy in the management of cutaneous head and neck melanoma. Plast Reconstr Surg 2005;115:721-8.