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 This is an original JCO publication from 2012. Please visit the JCO website to access the full article.

Sentinel Lymph Node Biopsy for Melanoma: An American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) Joint Clinical Practice Guideline


Sandra L. Wong, Charles M. Balch, Patricia Hurley, Sanjiv S. Agarwala, Timothy J. Akhurst, Alistair Cochran, Janice N. Cormier, Mark Gorman, Theodore Y. Kim, Kelly M. McMasters, R. Dirk Noyes, Lynn Mara Schuchter, Matias E. Valsecchi, Donald L. Weaver, Gary H. Lyman






  • Sentinel lymph node (SLN) biopsy for patients with newly diagnosed melanoma


Target Audience

  • Surgical Oncologists, Medical Oncologists, Dermatologists, Primary Care Physicians, Pathologists, Nuclear Medicine Specialists


Key Recommendations

  • Intermediate-thickness melanomas: SLN biopsy is recommended to patients with cutaneous melanomas with 1 to 4 mm Breslow thickness of any anatomic site.  
  • Thick melanomas: SLN biopsy may be recommended for staging purposes and to facilitate regional disease control for patients with melanomas that are T4 or > 4 mm Breslow thickness.
  • Thin melanomas: There is insufficient evidence to support routine SLN biopsy for patients with melanomas that are T1 or < 1 mm Breslow thickness, although it may be considered in selected high-risk cases.
  • Completion lymph node dissection is recommended for all patients with a positive SLN biopsy.



  • An Expert Panel was convened to develop clinical practice guideline recommendations based on their review of evidence from a systematic review of the medical literature.


Additional Information







Clinical Question


1)    What are the indications for sentinel lymph node biopsy?

Intermediate-thickness melanomas. SLN biopsy is recommended to patients with intermediate-thickness cutaneous melanomas (1 to 4 mm Breslow thickness) of any anatomic site. Routine use of SLN biopsy in this population provides accurate staging, with high estimates for PSM, and acceptable estimates for FNR, PTPN, and PPV.  


Thick melanomas. While there are few studies focusing specifically on patients with thick melanomas (T4; > 4 mm Breslow thickness), the use of SLN biopsy in this population may be recommended for staging purposes and to facilitate regional disease control.


Thin melanomas. There is insufficient evidence to support routine SLN biopsy for patients with thin melanomas (T1; < 1 mm Breslow thickness), although it may be considered in selected cases with high risk features, when the benefits of pathologic staging may outweigh the potential risks of the procedure. Such risk factors may include ulceration or mitotic rate ≥ 1/mm2, especially in the subgroup of patients with Breslow thickness 0.75 mm to 0.99 mm.


2)    What is the role of completion lymph node dissection?

CLND is recommended for all patients with a positive SLN biopsy. CLND achieves regional disease control, although whether or not CLND following a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II (MSLT II).





ASCO Guideline Disclaimer: The clinical practice guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. (“ASCO”) to assist practitioners in clinical decision making. The information therein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating physician, as the information does not account for individual variation among patients. Recommendations reflect high, moderate or low confidence that the recommendation reflects the net effect of a given course of action.  The use of words like “must,” “must not,” “should,” and “should not” indicate that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating physician in the context of treating the individual patient. Use of the information is voluntary.  ASCO provides this information on an “as is” basis, and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions.

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