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.