Table 1.

Summary of Clinical Practice Guideline Recommendations

Clinical Question	Recommendation
What are the indications for SLN biopsy?
Intermediate-thickness melanomas	SLN biopsy is recommended for patients with intermediate-thickness cutaneous melanomas (Breslow thickness, 1 to 4 mm) 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 PVP
Thick melanomas	Although there are few studies focusing specifically on patients with thick melanomas (T4; Breslow thickness, > 4 mm), 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; Breslow thickness, < 1 mm), although it may be considered in selected patients 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 melanomas 0.75 to 0.99 mm in Breslow thickness
What is the role of CLND?	CLND is recommended for all patients with positive SLN biopsy. CLND achieves regional disease control, although whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing MSLT II

Abbreviations: CLND, completion lymph node dissection; FNR, false-negative rate; MSLT II, Multicenter Selective Lymphadenectomy Trial II; PSM, proportion successfully mapped; PTPN, post-test probability negative; PVP, positive predictive value; SLN, sentinel lymph node.