< Current issue
Dermatopathology: Practical & Conceptual January - March 2006
5. New Heights: An assist to the next (10th) edition of “Lever’s”
Renata A. Joffe, M.D.
1. Small plaque parapsoriasis
2. Dysplastic nevus
3. Solar keratosis
4. Inverted follicular keratosis/trichilemmoma
5. Discoid lupus erythematosus vs. systemic lupus erythematosus
6. Lentigo maligna
7. Atopic dermatitis
8. Sebaceous adenoma
9. Muir-Torre syndrome
10. Bowen’s disease
11. Follicular mucinosis/alopecia mucinosa
12. Granuloma faciale and erythema elevatum diutinum
13. Follicular degeneration syndrome
14. Eccrine papillary adenoma
15. Degos’ disease
17. Proliferating tricholemmal cyst
18. Erythema multiforme (dermal and epidermal types)
19. Lichen sclerosus et atrophicus vs. morphea
20. Malignant melanoma (classification)
21. Malignant melanoma—ABCD’s
22. Malignant melanoma—wide/deep excision
23. Sentinel node biopsy for melanoma
24. Malignant melanoma: nontumorigenic compartment of primary malignant melanoma (radial growth phase), tumorigenic compartment of primary malignant melanoma (vertical growth phase)
25. Minimal deviation melanoma
26. Nevoid melanoma
27. Malignant melanoma—in infancy and childhood
28. Malignant blue nevus
29. MELTUMP and SAMPUS
30. Bulge activation hypothesis
23. Sentinel node biopsy for melanoma
Quotation from the 9th edition of Lever's:
"The sentinel node is identified as the first in the regional lymph node basis to contain these markers ("hot and blue"). Studies have demonstrated that if the sentinel node is negative, the probability of metastases being found in the remainder of the lymph node basin is very low indeed."
"The Association of Directors of Anatomic and Surgical Pathology (ADASP) has recently published guidelines for the processing of lymph nodes including sentinel nodes submitted for evaluation of metastatic disease. It is recommended that small nodes be submitted in their entirety or larger nodes be sections at 3- to 4-mm intervals and entirely submitted."
Reference in the 9th edition to concepts contrary by A. Bernard Ackerman et al. (ABA): None.
Statements contrary by ABA:
"Sentinel node biopsy provides no benefit to patients and, therefore, should be abandoned now. Surgery, in the form of dissection of a nodal basin, either an END [Elective lymph node dissection] or a node dissection following a SNB [Sentinel node biopsy], can neither cure a patient whose melanoma already has metastasized nor offer any benefit in terms of life expectancy.XThere 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."
Medalie NS, Ackerman AB. Sentinel lymph node biopsy has no benefit for patients with primary cutaneous melanoma: an assertion based on comprehensive, critical analysis:
Dermatopathology Practical and Conceptual
"Sentinel lymph node biopsy is a novelty destined to the same fate as elective node dissection and as wide and deep excision for melanoma. The reason sentinel lymph node biopsy and selective lymph node dissection in general are doomed to fail is that the main route of metastasis from primary melanoma is blood, not lymph!"
Ackerman AB, Szymanski MB. Sentinel lymph node biopsy?
Dermatopathology: Practical and Conceptual.
Other works of ABA in which the ideas contrary are expressed:
1. The Worthlessness of Sentinel Node Biopsy (SNB) for Patients with Primary Cutaneous Melanoma (video). Available at: www.derm101.com
This site is made possible in part by:
Copyright © Derm101.com. All Rights Reserved.