Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
In reply
We appreciate the letter by Dr Esmaeli. I have been aware of the potential advantages and pitfalls of sentinel node biopsies since Morton first described this technique a number of years ago. Unlike Dr Esmaeli, I believe our comments are correct, namely that sentinel node biopsies have limitations and that this case remains a cautionary note.1 The initial pathology reading was that the margins were clear. Because the patient developed postoperative pain and had V2 nerve involvement on imaging, other surgery was instituted, as described in our report. She remains disease-free almost 3 years later, so I will not address Dr Esmaeli's other therapeutic ideas.
Dr Esmaeli's disagreement with our statement that cutaneous eyelid melanomas with perineural invasion without sensory changes are very rare is different than the experience of both William Hoyt, MD, and me, as cited in our article.1 While both pigmented and nonpigmented eyelid malignancies can produce systematic perineural invasion, several series note that this is uncommon in cutaneous melanoma.2 It is interesting that, in a retrospective survey of eyelid melanomas from several centers, Esmaeli and colleagues3 did not mention perineural invasion and all sentinel node biopsies were negative.
A negative sentinel node biopsy is not as helpful as a positive one. We have seen this technique overused in low-risk conjunctival and eyelid malignancies. Other authors have discussed this problem in detail, and although Dr Esmaeli and her colleagues have been staunch proponents of this technique, while it is useful, it has significant limitations.4 We do agree with her that the use of this technique is mainly to predict local (regional) or systemic tumor recurrence.
Correspondence: Dr Char, The Tumori Foundation, California Pacific Medical Center, 45 Castro St, Ste 309, San Francisco, CA 94114 (tumori@tumori.org).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Archives of Ophthalmology editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.