Reply to comment on: Detailed Pathological Examination of Completion Node Dissection Specimens and Outcome in Melanoma Patients with Minimal (< 0.1 mm) Sentinel Lymph Node Metastases

Excerpt

We thank Madu and colleagues for their interest in our article on the incidence of non-sentinel lymph node involvement in melanoma patients with minimal tumor burden in sentinel nodes.1 There are a number of issues raised in their letter that we consider deserve further comment. Madu et al.’s statement that benefit from completion node dissection is negligible because only 0.29% of the lymph nodes were tumor-positive is misleading because it does not touch the heart of the matter, which is that additional metastatic nodal disease was found in one of our twenty patients i.e. 5%! They quote a large study in which patients with a minimal sentinel node metastasis did not undergo a node dissection but were observed for 5 years.2 In fact, the 5% of patients who developed nodal recurrence during follow up in that study concurs with our finding. So, there is agreement on the 5% risk of additional nodal involvement in melanoma patients with minimal tumor burden in their positive sentinel node. …