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We thank Dr. Pizarro for the opportunity to discuss the usefulness of sentinel lymph node biopsy (SLNB) in the treatment of cutaneous melanoma. In his letter he makes several points. The first is that lymphadenectomy can be curative if the affected nodes are dissected. We agree with this view: the survival curves to which he refers are not a description of the natural history of the disease (without intervention) but rather refer to patients who were followed up and in whom affected lymph nodes were excised when regional disease was detected. In this scenario, the alternative to SLNB is not inaction but rather observation and excision of affected nodes when metastasis is detected clinically or by ultrasound. We also agree that SLNB has no effect on patient survival. In a huge study undertaken to determine whether SLNB increased survival----the Multicenter Selective Lymphadenectomy Trial (MSTL-1)----1661 patients were randomized, starting in 1994, and were followed up for 10 years. This was such a remarkable effort that it is extremely unlikely to be repeated. The results of MSTL-1 provide a clear and definitive answer to the question posed above. The answer is that melanoma specific survival does not increase in patients who have undergone SLNB. And this is clear despite the opti-

actas dermo-sifiliográficas

Biopsia selectiva del ganglio centinela en melanoma: ni utilidad terapéutica, ni es buena para seleccionar los pacientes que podrían beneficiarse de la inmunoterapia adyuvante