Sentinel node (SN) biopsy was introduced in the 1990s as a means of reducing morbidity from elective lymphadenectomy in patients with invasive melanoma.1 Since then, clinicians have debated the rationale for its use in melanoma mangement.2-4 Our objective was to understand perspectives on current and future use, including knowledge of and attitudes towards SN biopsy.
Mixed-methods study using questionnaires (n=319) and semi-structured interviews (n=66) with GPs, dermatologists and key informants including representatives from melanoma education, training and consumer organisations, professional associations and colleges. Qualitative data analysis was informed by a determinants of practice framework.5
One-third (32%) of GPs and three-quarters (75%) of dermatologists described themselves as quite or very familiar with the national melanoma guidelines. Two-thirds (68%) of GPs and more than half (58%) of dermatologists thought SN biopsy had an important role in melanoma management. Almost all GPs and dermatologists (92% and 91%, respectively) reported Breslow thickness to be important in influencing referral for SN biopsy; however, only 39% of GPs and 66% of dermatologists correctly identified that SN biopsy is recommended for melanomas with a Breslow >1mm. Both GPs and dermatologists indicated SN biopsy was of value in assessing eligibility for adjuvant systemic therapies (67% and 79%, respectively), and in providing prognostic (71% and 60%, respectively) and staging information (71% and 53%, respectively).
Interview data indicated attitudes towards SN biopsy are shifting among GPs and dermatologists, driven by data from landmark clinical trials and the influence of professional networks. Key informants indicate use of SN biopsy was continuing to be refined. Factors influencing use included lack of confidence in the evidence base and resulting guidelines, the influence of professional organisations and opinion leaders, prevailing norms among specialties, financial incentives driven by healthcare funding policies, and non-financial incentives such as professional identity and professional standing.