![]() ![]() Currently, controversy exists in melanoma literature about whether to observe patients with clinical N0 disease or to perform an SLNB. Further questions arise about whether SLNB should be performed in all high-risk patients with clinically N0 SCC. Although lymph node dissection is recommended for patients with regional lymph node disease, no significant studies have determined whether this affects overall survival for patients with melanoma and nonmelanoma skin cancers. 6 An uncertainty to be explored is the next step in the treatment of patients with SCC and positive SLNB results. Some view this as a contraindication for performing SLNB, but the use of single-photon emission computed tomography and preoperative lymphoscintigraphy can substantially decrease this false-negative rate. Limitations to SLNB include false-negative rates, particularly high for tumors on the head and neck because of alternate draining routes and bifurcating anatomy. Given the cost and morbidity associated with prophylactic lymph node dissection, patients may benefit from a less invasive SLNB procedure before considering dissection. Overall, we found prophylactic lymph node dissection to be overused and SLNB is underused in high-risk SCC. 4 The SLNB positivity rate for stage 1B tumors is 7% to 10%, which is lower than that of high-risk SCC tumors. 3 The National Comprehensive Cancer Network guidelines recommend discussing and offering SLNB to patients with melanoma skin cancers of stages 1B and up. The reported positivity rate of SLNB in the setting of high-risk SCC in the literature is 12% to 44%. In a validation study by Schmitt et al, 2 tumors with 2 or 3 high-risk features had an SLNB positivity rate of 29%, whereas tumors with all 4 risk features had lymph node metastasis rate of 50%. T1 tumors have no high-risk features, whereas T2a tumors have 1, T2b have 2 to 3, and T3 have all 4 or bone invasion. This new staging system stratified T staging of SCC tumors based on the number of high-risk features present (>2-cm diameter, poor differentiation, perineural invasion, extension beyond subcutaneous fat). 1 Recent data have led to an updated staging system for cutaneous SCC proposed by Brigham and Women’s Hospital, which emphasizes the presence or absence of high-risk features. To date, the most important determinant of mortality in SCC is the presence of lymph node metastasis. With recent changes in staging of cutaneous squamous cell carcinoma (SSC), we examine the underuse of the sentinel lymph node biopsy (SLNB) in the management of high-risk SCC. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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