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
THE BOTTOM LINE
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).
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