Sentinel lymph node biopsy or nodal observation in melanoma: a prospective study of patient choices.
BACKGROUND
There is no consensus regarding the therapeutic utility of sentinel lymph node biopsy (SLNB) versus that of nodal observation (NO) in melanoma.


OBJECTIVE
To prospectively evaluate a standardized counseling procedure and its effect on patient choices to undergo SLNB or NO.


METHODS
In four centers, patients with melanoma eligible for SLNB or NO received a complete counseling procedure that included verbal information from dermatologists and surgeons, a detailed information sheet, and a written consent form. Data collected included patient and tumor characteristics, counseling conditions, and specialties of informing doctors. Factors influencing patients' choices were studied using multivariate analysis.


RESULTS
Of 343 consecutive patients, 309 were offered SLNB and NO and received complete verbal and written information from a dermatologist alone (62%) or in association with a surgeon (38%). Approximately half took advice from trusted persons, and half asked for additional time before making a decision; 268 (86.7%) ultimately decided to undergo SLNB. Multivariate analysis showed that older patients, those with a head and neck melanoma, and those informed without a surgeon present were more likely to prefer NO.


CONCLUSIONS
This counseling procedure was easily implemented in clinical practice. Patients favored SLNB but were able to understand uncertainties and express preferences.
Service de Dermatologie, Hôpital Robert Debré, Reims, France. fgrange@chu-reims.fr
Florent
F
Grange
Eve
E
Maubec
Coralie
C
Barbe
Jamal
J
Kassouma
Fabien
F
Vitry
Hubert
H
Johanet
Florence
F
Granel-Brocard
Francoise
F
Boitier
Angelique
A
Girod
Benoit
B
Couturaud
Pierre
P
Saez
Sebastien
S
Albert
Annick
A
Le Clainche
Vincent
V
Descamps
Marie Francoise
MF
Avril
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D037001:Directive Counseling; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000523:psychology* / Q000556:secondary*; D008875:Middle Aged; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*; D012878:Skin Neoplasms / Q000473:pathology* / Q000523:psychology*; D055815:Young Adult