Daniel G. Coit, MD, FACS

Malignant small bowel tumors are extremely rare, accounting for 0.1% to 0.3% of all malignancies. Fewer than 2,400 new cases of small bowel malignancy are reported in the United States each year.[1] Malignant tumors, which account for about two-thirds of all primary small bowel tumors, consist of four primary subtypes: adenocarcinoma, carcinoid tumor, lymphoma, and sarcoma (or gastrointestinal [GI] stromal tumor). Each malignancy is characterized by unique predisposing factors, anatomy, and biology. The prevalence, pattern, and relevance of both regional lymph node and distant metastases differ. As a result, the study of malignant small bowel tumors, taken as an aggregate, is fraught with difficulty.

Gastric carcinoma is a discouraging disease. Although we can clearly identify patient- and tumor-related variables that predict outcome, the only reproducible treatment- related variable associated with an improvement in survival is a complete (R0) resection.[1]

Neugut and colleagues have compiled a very comprehensive, thoughtful description of the incidence, epidemiology, etiology, clinical presentation, and treatment of small bowel malignancies. This is a very unusual tumor that few clinicians will encounter during their careers, and fewer still will diagnose preoperatively.

Drs. North and Spellman concisely review the role of sentinel node biopsy in the management of patients with malignant melanoma and provide an excellent summary of the current state of this technique. A number of comments should be made about this review. These comments relate to (1) the technical aspects of the procedure and (2) its clinical indications.