Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 May 16;2015(5):CD010307.
doi: 10.1002/14651858.CD010307.pub2.

Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma

Athanassios Kyrgidis  1 , Thrasivoulos Tzellos, Simone Mocellin, Zoe Apalla, Aimilios Lallas, Pierluigi Pilati, Alexander Stratigos
Affiliations

Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma

Athanassios Kyrgidis et al. Cochrane Database Syst Rev. .

Abstract

Background: Melanoma is the leading cause of skin cancer-associated mortality. The vast majority of newly diagnosed melanomas are confined to the primary cutaneous site. Surgery represents the mainstay of melanoma treatment. Treatment strategies include wide excision of the primary tumour and sentinel lymph node biopsy (SLNB) to assess the status of the regional nodal basin(s). SLNB has become an important component of initial melanoma management providing accurate disease staging.

Objectives: To assess the effects and safety of SLNB followed by completion lymph node dissection (CLND) for the treatment of localised primary cutaneous melanoma.

Search methods: We searched the following databases up to February 2015: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2015, Issue 1), MEDLINE (from 1946), EMBASE (from 1974), and LILACS ((Latin American and Caribbean Health Science Information database, from 1982). We also searched the following from inception: African Index Medicus, IndMED of India, Index Medicus for the South-East Asia Region, and six trials registers. We checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). We searched ISI Web of Science Conference Proceedings from inception to February 2015, and we scanned the abstracts of major dermatology and oncology conference proceedings up to 2015.

Selection criteria: Two review authors independently assessed all RCTs comparing SLNB followed by CLND for the treatment of primary localised cutaneous melanoma for inclusion. Primary outcome measures were overall survival and rate of treatment complications and side effects.

Data collection and analysis: Two review authors independently extracted and analysed data on survival and recurrence, assessed risk of bias, and collected adverse effect information from included trials.

Main results: We identified and included a single eligible trial comparing SLNB with observation and published in eight different reports (from 2005 to 2014) with 2001 participants. This did not report on our first primary outcome of overall survival. The study did report on the rate of treatment complications. Our secondary outcomes of disease-specific and disease-free survival, local recurrence and distant metastases were reported. There were 1347 participants in the intermediate-thickness melanoma group and 314 in the thick melanoma group.With regard to treatment complications, short-term surgical morbidity (30 days) in 1735 participants showed no difference between SLNB and observation (risk ratio [RR] 1.11; 95% confidence interval [CI] 0.9 to 1.37) for wide excision of the tumour site but favoured observation for complications related to the regional nodal basin (RR 14.36; 95% CI 6.74 to 30.59).The study did not report the actual 10-year melanoma-specific survival rate for all included participants. Instead, melanoma-specific survival rates for each group of participants: intermediate-thickness melanoma (defined as 1.2 to 3.5 mm) and thick melanomas (defined as 3.50 mm or more) was reported.In the intermediate-thickness melanoma group there was no statistically significant difference in disease-specific survival between study groups at 10 years (81.4 ± 1.5% versus 78.3 ± 2.0%, hazard ratio [HR] 0.84; 95% CI 0.65 to 1.09). In the thick melanoma group, again there was no statistically significant difference in disease-specific survival between study groups at 10 years (58.9.3 ± 4.1% versus 64.4 ± 4.6%, HR 1.12; 95% CI 0.77 to 1.64). Combining these groups there was some heterogeneity (I² = 34%) but the total HR was not statistically significant (HR 0.92; 95% CI 0.74 to 1.14). This study failed to show any difference for its stated primary outcome.The summary estimate for disease-free survival at 10 years favoured SLNB over observation in participants with intermediate-thickness and thick melanomas (HR 0.75; 95% CI 0.63 to 0.89).With regard to the rate of local and regional recurrence as the site of first recurrence, a benefit of SLNB uniformly existed in both groups of participants with intermediate-thickness and thick melanomas (RR 0.56; 95% CI 0.45 to 0.69). This is in contrast with a uniformly unfavourable effect of SLNB with regard to the rate of distant metastases as site of first recurrence, in both groups of participants with intermediate-thickness and thick melanomas (HR 1.33; 95% CI 1.03 to 1.72).

Authors' conclusions: We contacted the trial authors querying the lack of data on overall survival which was the primary outcome of their important study. They stated "there are numerous additional analyses that have yet to be reported for the trial". We expect that overall survival data will be available in a future update of this review.Disease-free survival and rate of local and regional recurrence favoured SLNB in both groups of participants with intermediate-thickness and thick melanomas but short-term surgical morbidity was higher in the SLNB group, especially with regard to complications in the nodal basin.The evidence for the outcomes of interest in this review is of low quality due to the risk of bias and imprecision of the estimated effects. Further research may have an important impact on our estimate of the effectiveness of SLNB in managing primary localised cutaneous melanoma. Currently this evidence is not sufficient to document a benefit of SLNB when compared to observation in individuals with primary localised cutaneous melanoma.

PubMed Disclaimer

Conflict of interest statement

Athanassios Kyrgidis: nothing to declare

Thrasivoulos Tzellos: nothing to declare

Simone Mocellin: nothing to declare

Zoe Apalla: nothing to declare

Aimilios Lallas: nothing to declare

Pierluigi Pilati: nothing to declare

Alexander Stratigos: nothing to declare

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 1 Overall Survival PP.
1.2
1.2. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 2 Overall Survival ITT.
1.3
1.3. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 3 Overall Survival Best Case ITT.
1.4
1.4. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 4 Overall Survival Worst Case ITT.
1.5
1.5. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 5 Surgical Morbidity (Within 30 d) Related to Wide Excision of the Primary Site in Patients Assigned to the 2 Treatment Groups of MSLT‐I.
1.6
1.6. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 6 Surgical Morbidity (Within 30 d): Nodal Basin Complications.
1.7
1.7. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 7 Surgical Morbidity (Within 30 d): Regional Complications.
1.8
1.8. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 8 Surgical Morbidity (Within 30 d): Systemic Complications.
1.9
1.9. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 9 Surgical Morbidity (Within 30 d) Related to the Regional Nodal Basin in Patients Assigned to the 2 Treatment Groups of MSLT‐I.
1.10
1.10. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 10 Disease‐specific survival.
1.11
1.11. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 11 Disease‐free survival.
1.12
1.12. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 12 Rate of pathologically confirmed locoregional recurrence as site of first recurrence.
1.13
1.13. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 13 Rate of development of distant metastases as site of first recurrence.
1.14
1.14. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 14 Rate of development of local, In‐transit and distant recurrences as site of first recurrence.
1.15
1.15. Analysis
Comparison 1 SLNB versus Observation for melanoma, Outcome 15 Rate of development of local and In‐transit recurrences as site of first recurrence.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

MSLT‐I {published data only}
    1. Faries MB, Thompson JF, Cochran A, Elashoff R, Glass EC, Mozzillo N, et al. The impact on morbidity and length of stay of early versus delayed complete lymphadenectomy in melanoma: results of the Multicenter Selective Lymphadenectomy Trial (I). Annals of Surgical Oncology 2010;17(12):3324‐9. [MEDLINE: ] - PMC - PubMed
    1. Garreau JR, Faries M, Ye X, Morton D. Mood state and melanoma outcome in the Multicenter Selective Lymphadenectomy Trial. Journal of Clinical Oncology 2009;27(15 Suppl 1):9603. [EMBASE: 70242875]
    1. Howard JH, Thompson JF, Mozzillo N, Nieweg OE, Hoekstra HJ, Roses DF, et al. Metastasectomy for distant metastatic melanoma: analysis of data from the first Multicenter Selective Lymphadenectomy Trial (MSLT‐I). Annals of Surgical Oncology 2012;19(8):2547‐55. [MEDLINE: ] - PMC - PubMed
    1. Morton DL. Overview and update of the phase III Multicenter Selective Lymphadenectomy Trials (MSLT‐I and MSLT‐II) in melanoma. Clinical & Experimental Metastasis 2012;29(7):699‐706. [MEDLINE: ] - PMC - PubMed
    1. Morton DL, Cochran AJ, Thompson JF, Elashoff R, Essner R, Glass EC, et al. Sentinel node biopsy for early‐stage melanoma: accuracy and morbidity in MSLT‐I, an international multicenter trial. Annals of Surgery 2005;242(3):302‐11. [MEDLINE: ] - PMC - PubMed

References to studies excluded from this review

Hauschild 2010 {published data only}
    1. Hauschild A, Weichenthal M, Rass K, Linse R, Berking C, Böttjer J, et al. Efficacy of low‐dose interferon {alpha}2a 18 versus 60 months of treatment in patients with primary melanoma of >= 1.5 mm tumor thickness: results of a randomized phase III DeCOG trial. Journal of Clinical Oncology 2010;28(5):841‐6. [MEDLINE: ] - PubMed
Korovin 2013 {published data only}
    1. Korovin S, Kukushkina M, Solodiannikova O, Sukach G, Potorocha A, Palivets A, et al. Therapeutic value of removing sentinel lymph nodes in melanoma patients (interim results). JDDG ‐ Journal of the German Society of Dermatology 2013;11:59. [EMBASE: 71143145]
McMasters 2010 {published data only}
    1. McMasters KM. The Sunbelt Melanoma Trial. Annals of Surgical Oncology 2001;8(9 Suppl):41S‐43S. [MEDLINE: ] - PubMed
Reintgen 2004 {published data only}
    1. Reintgen DS, Jakub JW, Pendas S, Swor G, Giuliano R, Shivers S. The staging of malignant melanoma and the Florida Melanoma Trial. Annals of Surgical Oncology 2004;11(3 Suppl):186S‐191S. [MEDLINE: ] - PubMed

Additional references

Altman 1999
    1. Altman DG, Andersen PK. Calculating the number needed to treat for trials where the outcome is time to an event. BMJ 1999;319(7223):1492‐5. [MEDLINE: ] - PMC - PubMed
Altstein 2013
    1. Altstein L, Li G. Latent subgroup analysis of a randomized clinical trial through a semiparametric accelerated failure time mixture model. Biometrics 2013;69(1):52‐61. [MEDLINE: ] - PMC - PubMed
Austin 2011
    1. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research 2011;46(3):399‐424. - PMC - PubMed
Balch 2001
    1. Balch CM, Soong SJ, Gershenwald JE, Thompson JF, Reintgen DS, Cascinelli N, et al. Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer Melanoma Staging System. Journal of Clinical Oncology 2001;19(16):3622‐34. [MEDLINE: ] - PubMed
Balch 2004
    1. Balch CM, Soong SJ, Atkins MB, Buzaid AC, Cascinelli N, Coit DG, et al. An evidence‐based staging system for cutaneous melanoma. CA: a Cancer Journal for Clinicians 2004;54(3):131‐49. [MEDLINE: ] - PubMed
Balch 2009
    1. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. Journal of Clinical Oncology 2009;27(36):6199‐206. [MEDLINE: ] - PMC - PubMed
Balch 2011
    1. Balch CM, Gershenwald JE, Soong SJ, Thompson JF. Update on the melanoma staging system: the importance of sentinel node staging and primary tumor mitotic rate. Journal of Surgical Oncology 2011;104(4):379‐85. [MEDLINE: ] - PubMed
Bevona 2002
    1. Bevona C, Sober AJ. Melanoma incidence trends. Dermatologic Clinics 2002;20(4):589‐95. [MEDLINE: ] - PubMed
Bichakjian 2011
    1. Bichakjian CK, Halpern AC, Johnson TM, Foote Hood A, Grichnik JM, Swetter SM, et al. Guidelines of care for the management of primary cutaneous melanoma. American Academy of Dermatology. Journal of the American Academy of Dermatology 2011;65(5):1032‐47. [MEDLINE: ] - PubMed
Boland 2012
    1. Boland GM, Gershenwald JE. Sentinel lymph node biopsy in melanoma. Cancer Journal 2012;18(2):185‐91. [MEDLINE: ] - PubMed
Callender 2011
    1. Callender GG, Egger ME, Burton AL, Scoggins CR, Ross MI, Stromberg AJ, et al. Prognostic implications of anatomic location of primary cutaneous melanoma of 1 mm or thicker. American Journal of Surgery 2011;202(6):659‐64. [MEDLINE: ] - PubMed
Chagpar 2007
    1. Chagpar RB, Ross MI, Reintgen DS, Edwards MJ, Scoggins CR, Martin RC, et al. Factors associated with improved survival among young adult melanoma patients despite a greater incidence of sentinel lymph node metastasis. Journal of Surgical Research 2007;143(1):164‐8. [MEDLINE: ] - PubMed
Chao 2004
    1. Chao C, Martin RC, Ross MI, Reintgen DS, Edwards MJ, Noyes RD, et al. Correlation between prognostic factors and increasing age in melanoma. Annals of Surgical Oncology 2004;11(3):259‐64. [MEDLINE: ] - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7(3):177‐88. [MEDLINE: ] - PubMed
Divito 2010
    1. Divito SJ, Ferris LK. Advances and short comings in the early diagnosis of melanoma. Melanoma Research 2010;20(6):450‐8. [MEDLINE: ] - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. [MEDLINE: ] - PMC - PubMed
Erdmann 2012
    1. Erdmann F, Lortet‐Tieulent J, Schüz J, Zeeb H, Greinert R, Breitbart EW, et al. International trends in the incidence of malignant melanoma 1953‐2008 ‐ are recent generations at higher or lower risk?. International Journal of Cancer 2012 May 21 [Epub ahead of print]. - PubMed
Fawzy 2012
    1. Fawzy M, Garioch J, Igali L, Skrypniuk JV, Moncrieff MD. Setting up an effective and efficient sentinel node biopsy service for malignant melanoma within the NHS. Journal of Plastic, Reconstructive & Aesthetic Surgery 2012;65(3):351‐5. [MEDLINE: ] - PubMed
Ferlay 2010
    1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International Journal of Cancer 2010;127(12):2893‐917. [MEDLINE: ] - PubMed
Francischetto 2010
    1. Francischetto T, Spector N, Neto Rezende JF, Azevedo Antunes M, Oliveira Romano S, Small IA, et al. Influence of sentinel lymph node tumor burden on survival in melanoma. Annals of Surgical Oncology 2010;17(4):1152‐8. [MEDLINE: ] - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Jemal 2011a
    1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: a Cancer Journal for Clinicians 2011;61(2):69‐90. [MEDLINE: ] - PubMed
Jemal 2011b
    1. Jemal A, Saraiya M, Patel P, Cherala SS, Barnholtz‐Sloan J, Kim J, et al. Recent trends in cutaneous melanoma incidence and death rates in the United States, 1992‐2006. Journal of the American Academy of Dermatology 2011;65(5 Suppl 1):S17‐25. [MEDLINE: ] - PubMed
Kretschmer 2006
    1. Kretschmer L, Hilgers R. Research supports the view that sentinel node biopsy Is the standard of care in high‐risk primary melanoma. Journal of Clinical Oncology 2006;24(18):2965‐6. [MEDLINE: ] - PubMed
Kyrgidis 2013
    1. Kyrgidis A, Tzellos T, Mocellin S, Apalla Z, Lallas A, Pilati P, Stratigos A. Sentinel lymph node biopsy followed by lymph node dissection for early cutaneous melanoma. Cochrane Database of Systematic Reviews 2013, Issue 1. [DOI: 10.1002/14651858.CD010307] - DOI - PMC - PubMed
Leong 2011
    1. Leong SP. Role of selective sentinel lymph node dissection in head and neck melanoma. Journal of Surgical Oncology 2011;104(4):361‐8. [MEDLINE: ] - PubMed
Miller 2006
    1. Miller AJ, Mihm MC. Melanoma. New England Journal of Medicine 2006;355(1):51‐65. [MEDLINE: ] - PubMed
Mocellin 2008
    1. Mocellin S, Zavagno G, Nitti D. The prognostic value of serum S100B in patients with cutaneous melanoma: a meta‐analysis. International Journal of Cancer 2008;123(10):2370‐6. [MEDLINE: ] - PubMed
Mocellin 2011a
    1. Mocellin S, Pasquali S, Nitti D. The impact of surgery on survival of patients with cutaneous melanoma: revisiting the role of primary tumor excision margins. Annals of Surgery 2011;253(2):238‐43. [MEDLINE: ] - PubMed
Mocellin 2011b
    1. Mocellin S, Lens MB, Pasquali S, Pilati P. Interferon alpha for the adjuvant treatment of cutaneous melanoma. Cochrane Database of Systematic Reviews 2011, Issue 1. [DOI: 10.1002/14651858.CD008955] - DOI - PMC - PubMed
Mocellin 2011c
    1. Mocellin S, Nitti D. Cutaneous melanoma in situ: translational evidence from a large population‐based study. Oncologist 2011;16(6):896‐903. [MEDLINE: ] - PMC - PubMed
Moher 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. PLoS Medicine 2009;6(7):e1000097. [MEDLINE: ] - PMC - PubMed
Morton 2001
    1. Morton DL. Lymphatic mapping and sentinel lymphadenectomy for melanoma: past, present, and future. Annals of Surgical Oncology 2001;8(9 Suppl):22S‐28S. [MEDLINE: ] - PubMed
Morton 2006
    1. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel‐node biopsy or nodal observation in melanoma. New England Journal of Medicine 2006;355(13):1307‐17. [MEDLINE: ] - PubMed
Morton 2008
    1. Morton DL, Cochran AJ, Thompson JF. The rationale for sentinel‐node biopsy in primary melanoma. Nature Clinical Practice Oncology 2008;5(9):510‐11. [MEDLINE: ] - PMC - PubMed
Parmar 1998
    1. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta‐analyses of the published literature for survival endpoints. Statistics in Medicine 1998;17(24):2815‐34. [MEDLINE: ] - PubMed
Ross 2010
    1. Ross MI. Sentinel node biopsy for melanoma: an update after two decades of experience. Seminars in Cutaneous Medicine & Surgery 2010;29(4):238‐48. [MEDLINE: ] - PubMed
Ross 2011
    1. Ross MI, Gershenwald JE. Evidence‐based treatment of early‐stage melanoma. Journal of Surgical Oncology 2011;104(4):341‐53. [MEDLINE: ] - PubMed
Sladden 2009
    1. Sladden MJ, Balch C, Barzilai DA, Berg D, Freiman A, Handiside T, Hollis S, Lens MB, Thompson JF. Surgical excision margins for primary cutaneous melanoma. Cochrane Database of Systematic Reviews 2009, Issue Issue 4. Art. No.: CD004835. DOI: 10.1002/14651858.CD004835.pub2. [DOI: 10.1002/14651858.CD004835.pub2] - DOI - PubMed
Sladden 2015
    1. Sladden M, Zagarella S, Popescu C, Bigby M. No survival benefit for patients with melanoma undergoing sentinel lymph node biopsy: critical appraisal of the Multicenter Selective Lymphadenectomy Trial‐I final report. The British journal of dermatology 2015;172:566‐571. - PubMed
Sutton 2000
    1. Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F. Methods for meta‐analysis in medical research. First Edition. Chichester: Wiley‐Blackwell, 2000.
Thomas 2004
    1. Thomas JM, Clark MA. Selective lymphadenectomy in sentinel node‐positive patients may increase the risk of local/in‐transit recurrence in malignant melanoma. European Journal of Surgical Oncology 2004;30(6):686‐91. [MEDLINE: ] - PubMed
Thomas 2008a
    1. Thomas JM. Sentinel lymph node biopsy in malignant melanoma. BMJ 2008;336(7650):902‐3. [MEDLINE: ] - PMC - PubMed
Thomas 2008b
    1. Thomas JM. Prognostic false‐positivity of the sentinel node in melanoma. Nature Clinical Practice Oncology 2008;5(1):18‐23. [MEDLINE: ] - PubMed
Thomas 2009
    1. Thomas JM. Concerns relating to the conduct and statistical analysis of the Multicenter Selective Lymphadenectomy Trial (MSLT‐1) in patients with melanoma. Journal of Plastic, Reconstructive & Aesthetic Surgery 2009;62(4):442‐6. [MEDLINE: ] - PubMed
Thomas 2014
    1. Thomas JM. Sentinel‐node biopsy in melanoma. N Engl J Med. 2014;370:2148. - PubMed
Thompson 2006
    1. Thompson JF, Shaw HM. Benefits of sentinel node biopsy for melanoma: a review based on interim results of the first Multicenter Selective Lymphadenectomy Trial. ANZ Journal of Surgery 2006;76(3):100‐3. [MEDLINE: ] - PubMed
Thompson 2009
    1. Thompson JF, Scolyer RA, Kefford RF. Cutaneous melanoma in the era of molecular profiling. Lancet 2009;374(9687):362‐5. [MEDLINE: ] - PubMed
Thompson 2014
    1. Thompson JF, Cochran AJ, Faries MB. Sentinel‐node biopsy in melanoma.. N Engl J Med. 2014;370:2149‐2150.. - PMC - PubMed
Tierney 2007
    1. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time‐to‐event data into meta‐analysis. Trials 2007;8(16):1‐16. [MEDLINE: ] - PMC - PubMed
Tzellos 2013
    1. Tzellos T, Toulis KA, Dessinioti C, Zampeli V, Abdel‐Naser MB, Katsambas A, et al. Topical retinoids for the treatment of acne vulgaris. Cochrane Database of Systematic Reviews 2013, Issue 8. [DOI: 10.1002/14651858.CD009470.pub2] - DOI
Tzellos 2014
    1. Tzellos T, Kyrgidis A, Mocellin S, Chan A, Pilati P, Apalla Z. Interventions for melanoma in situ, including lentigo maligna. Cochrane Database of Systematic Reviews 2014, Issue 12. [DOI: 10.1002/14651858.CD010308.pub2] - DOI - PMC - PubMed
Valsecchi 2011
    1. Valsecchi ME, Silbermins D, Rosa N, Wong SL, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta‐analysis. Journal of Clinical Oncology 2011;29(11):1479‐87. [MEDLINE: ] - PubMed
Wen 2011
    1. Wen DR, Cochran AJ, Huang RR, Itakura E, Binder S. Clinically relevant information from sentinel lymph node biopsies of melanoma patients. Journal of Surgical Oncology 2011;104(4):369‐78. [MEDLINE: ] - PubMed
Wong 2012
    1. Wong SL, Balch CM, Hurley P, Agarwala SS, Akhurst TJ, Cochran A, et al. Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. Journal of Clinical Oncology 2012;30(23):2912‐8. [MEDLINE: ] - PMC - PubMed
Yang 2014
    1. Yang JC, Sherry RM, Rosenberg SA. Why is sentinel lymph node biopsy ‘standard of care’ for melanoma?. National Review of Clinical Oncology 2014;11:245–246. - PMC - PubMed

Publication types