SLNB claims lead to article retractions

Skin cancers

By Michael Woodhead

13 Nov 2019

Controversial claims about the lack of benefit of sentinel lymph node biopsy (SLNB) in the management of melanoma has led to the retraction of two papers published by Australian clinicians in the official journal of the RACGP.

The Australian Journal of General Practice has announced the retraction of “Management of invasive melanoma”, a discussion paper published in its June issue by Professor Anthony Dixon and colleagues from the Australasian College of Cutaneous Oncology, Melbourne. A second article by the same authors, “Cutaneous melanoma: Latest developments”, was also retracted.

The articles stated aims were to “identify suboptimal aspects of melanoma management” and explain the place of sentinel lymph node biopsy (SLNB)  in patients with melanoma.

However the journal has now posted the following statement in their place:

“This article has been retracted by the Australian Journal of General Practice for the following reason: A Letter to the Editor from Professor John Thompson, Melanoma Institute, reported that this article contained a large number of factual errors that undermined the reliability of the overall article. After consultation with our expert independent advisory panel, we have retracted the entire article.”

In addition to Professor Thompson, the letter to the editor was signed by 15 clinicians including Associate Professor Stephen Shumack, chair of the Australasian College of Dermatology’s expert advisory committee, Associate Professor Victoria Mar, the Director of the Victorian Melanoma Service and Professor Peter Soyer, Director, Dermatology Research Centre, Diamantina Institute, University of Queensland.

Professor Shumack told the limbic that the retraction was requested because the articles contained several errors including claims that there had been no recently updated evidence guidelines published for melanoma in Australia.

“Dermatologists will be aware that the updated evidence-based clinical guidelines for melanoma were released last year and we would hope they are aware of the content, particularly in relation to the latest evidence for drug therapies,” he said.

Professor Shumack said an important aspect of the new melanoma guidelines was that SLNB was an important prognostic indicator and it could guide patients to access new treatments such as immunotherapy that have been shown to extend survival.

The retracted papers follow a previous article for the journal by Professor Dixon, in which he argued that SLNB should no longer be considered part of routine management of invasive melanoma.  In his 2014 article, Professor Dixon said MSLT trial findings published in the NEJM showed that SLNB does not alter survival prospects. He also noted that SLNB has a 10% complication rate.

Current Cancer Council Australia clinical guidelines for melanoma recommend that SLNB  “should be considered for all patients with melanoma greater than 1 mm in thickness and for patients with melanoma greater than 0.75 mm with other high risk pathological features to provide optimal staging and prognostic information and to maximise management options for patients who are node positive.”

This recommendation is given a B grade under NHMRC criteria, defined as a body of evidence that “can be trusted to guide practice in most situations. Recommendation based on good evidence. Strongly recommended for implementation.”

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