Recommendations for sentinel lymph node biopsy |
-
For all SLNB-eligible
patients, careful discussion of the risks and benefits of the
procedure involving surgical oncology input is recommended.
-
SLNB is not recommended
for patients with MIS or for most T1a CM (<0.8 mm without ulceration
per the eighth edition of the AJCC staging system)
-
SLNB should be discussed
and offered in appropriate patients with CM >1 mm thickness (≥T2a),
including T4 CM
-
In patients with T1b CM
(<0.8 mm with ulceration or 0.8-1.0 mm with or without ulceration
per the eighth edition of the AJCC staging system), SLNB should be
discussed and considered, though rates of SLN positivity are still
relatively low.
-
SLNB may be considered
for T1a CM if other adverse features are present, including young
age, presence of lymphovascular invasion, positive deep biopsy
margin (if close to 0.8 mm), high mitotic rate, or a combination of
these factors.
-
Interdisciplinary
collaboration involving surgical and medical oncologists is
recommended for discussion of possible completion lymph node
dissection vs regional nodal ultrasound surveillance in the event of
a positive SLNB
|
AJCC, American Joint
Committee on Cancer; CM, cutaneous melanoma; MIS,
melanoma in situ; SLN, sentinel lymph node; SLNB,
sentinel lymph node biopsy |
Reasons not to perform SLNB include advanced age, poor functional
status, and/or comorbid conditions that portend a short life expectancy
or preclude general anesthesia or subsequent treatment. As age increases,
SLNs become more difficult to identify and rates of SLN positivity
decline. Although SLNB may have less prognostic value and may be
technically more difficult in older individuals, there is currently no
consensus for an upper age cutoff to recommend against this procedure.
Each case should be discussed individually, and in conjunction with
surgical oncology colleagues, with the decision to pursue pathologic
staging of the regional LNs based on patient comorbidities and how that
information may affect further management. |