SLNB is generally agreed to be useful as a staging procedure in patients with primary cutaneous melanoma, but no randomised trials have yet shown any therapeutic benefit in patients who have undergone SLNB. A randomised multicentre trial is now comparing survival after wide excision alone versus wide excision plus SLNB in patients with cutaneous melanoma (1 mm in depth or Clark level IV). The trial has been underway for 5 years and 11 000 patients had already been recruited by 1999.41

There are additional potential benefits of accurate staging in patients with positive results if adjuvant treatments such as interferon prove to be of value.

Once patients with MM develop distant metastatic disease the prognosis is poor. There is therefore a need to investigate additional or adjuvant treatments which may be given either after primary tumour resection in those with thicker lesions in patients who appear to have non-metastatic disease or after regional lymph node resection in those with established metastatic disease.

The role of adjuvant treatments, mainly in the form of interferon alfa-2b, is still controversial. Several studies have shown that interferon alfa has a biologically modifying effect on MM but the effect on overall survival has been variable. Side-effects are a major problem with patients receiving high-dose interferon alfa.

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