Fast Five Quiz: Are You Able to Identify and Treat Melanomas?

Winston Tan, MD


June 02, 2015

Guidelines from the National Comprehensive Cancer Network (NCCN) suggest that it is reasonable to offer sentinel lymph node biopsy to patients with thick melanoma (≥ 4 mm or greater) in whom the probability of a positive sentinel node is 30%-40% and in whom sentinel lymph node status is a strong independent predictor of outcome. Sentinel node biopsy may be offered either as standard care or in the context of a clinical trial.

The NCCN does not recommend sentinel lymph node biopsy for patients with in situ melanoma (stage 0) or stage IA melanoma that is 1 mm or less with no adverse features. Although there appears to be a subset of patients with thin melanoma who are at sufficient risk for a positive sentinel lymph node to justify a biopsy, there is not yet clear consensus regarding which factors best predict this risk. Possible factors include thickness over 0.75 mm, high mitotic rate, and young patient age; other possible factors include positive deep margins and lymphovascular invasion.

Joint guidelines from the American Society of Clinical Oncology (ASCO) and the Society of Surgical Oncology (SSO) recommend sentinel lymph node biopsy for patients with intermediate-thickness melanomas (Breslow thickness 1-4 mm) of any anatomic site. Less evidence supports sentinel lymph node biopsy patients with thick melanomas (T4; Breslow thickness > 4 mm), but it is recommended for staging and facilitating regional disease control. Evidence supporting routine sentinel lymph node biopsy for patients with thin melanomas (T1; Breslow thickness < 1 mm) is lacking.

For more about the workup of melanoma, read here.


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