Is sentinel node biopsy the standard of care in melanoma management? The opinions and practices of Australian specialists

Abstract

There is international debate over the role of sentinel node biopsy (SNB) in invasive melanoma management. There is currently evidence that SNB offers prognostic information; however, the therapeutic benefit of SNB is yet to be elucidated. Many experts describe SNB as the standard of care in the management of patients with melanoma. Labelling a procedure as a standard of care has consequences from the perspectives of both patient care and cost. This study aims to determine the opinions of Australian dermatologists and plastic surgeons on the role of SNB, to compare these opinions between specialties and to compare self-reported practices with current evidence. An online survey of 10 questions was distributed to members of the Australasian College of Dermatologists and the Australian Society of Plastic Surgeons. A total of 137 responses were received (66 dermatologists and 71 plastic surgeons), representing 16% of the dermatologists and 20% of the plastic surgeons in Australia. Just over half of the respondents (51%) said SNB should not be the standard of care. More dermatologists than plastic surgeons held this view. In total 15% of specialists were counselling patients outside current guidelines. Australian specialists are divided on the role of SNB in the management of patients with melanoma. There are differences in opinion on the role of SNB in melanoma management between speciality groups and regions. A significant percentage of specialists are counselling patients outside current guidelines.