Surgery, in the form of dissection of a nodal basin, either an END or a node dissection following a SNB, can neither cure a patient whose melanoma already has metastasized nor offer any benefit in terms of life expectancy. Moreover, no effective adjuvant medical treatment exists currently for metastatic melanoma. Treatment with interferon alpha-2b in high dose has no benefit, and actually may be detrimental to a patient. Side effects, often devastating ones, occur in 100% of patients who receive that therapy in high dosage, necessitating reduction in the dose of it. Death may ensue as a consequence of treatment with interferon alpha-2b.

There is no compelling, substantiated evidence that SNB has any efficacy at all and that is precisely why sensible investigators have cautioned repeatedly that SNB should be limited solely to clinical trials. Metastasis of melanoma to regional nodes is exceedingly rare in patients with a melanoma thinner than 0.76 mm, and SNB in such a circumstance almost always is productive of a node negative for cells of melanoma. Nonetheless, SNB has been offered to those patients (http://www.stopmelanoma.com, a Web page no longer active) by physicians who are uninformed, uncritical, or insensitive to the best interests of patients. A negative SNB in patients with a melanoma thicker than 0.76 mm is no guarantee that a patient does not truly have metastases, for which no effective treatment is now available. Simply stated, outside of clinical trials, there is no indication medically for SNB.

In sum and in short, the evidence is incontrovertible: SNB has no worth at all. If the SN is negative it means nothing vis-à-vis metastasis having already occurred, and if it is positive it means a lot, namely, that melanoma has disseminated far beyond the node with likely fatal consequence, in time, for the patient who bears those metastases. Cells of a metastasis of melanoma do not simply germinate in a SN, but pass through them, bypass them, and even bypass secondary nodes. The evidence in the literature that pertains to metastasis of melanoma, some of it culled from articles devoted to SNB, gives the lie to the notion that metastases of melanoma progress in an orderly, sequential, predictable fashion. On the contrary, it conveys clearly that once cells of melanoma gain access to lymph vessels or blood vessels, they metastasize widely, proliferate at variable rates, and, in time, become manifest clinically and result in death. A SNB does nothing to alter the course of melanoma, not by itself, not in conjunction with dissection of a nodal basin, and not in combination with any adjuvant medical therapy available currently.