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Socrates might not have been pleased with Dr. Zitelli's article, because it contains several opinions that are not supported by facts. The published results of MSLT-I are not final results but those of a planned third interim analysis, with two more analyses yet to be performed. Metastatic melanoma may not become apparent for many years, so we must keep an open mind as to the eventual results. The erroneous assumption that "final" results are now available underpins Dr. Zitelli's claim that sentinel node (SN) biopsy had a 25% "false positivity" rate in the trial. This overlooks the fact that patients in the observation group are still developing regional node metastases at a rate indicating that by 10 years the observation group proportion who develop clinically detectable disease will be equivalent to the SN-positive proportion (including those with false-negative results).
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