Table 12.
Recommendations for sentinel lymph node biopsy.
| Breslow thickness + other characteristics | NCCN recommendation* | ASCO + SSO recommendations** | % positive SLN |
|---|---|---|---|
| Stage IA (T1a): <0.8 with no ulceration | Not recommended, unless uncertain about adequacy of biopsy staging | Not recommded | <5% |
| Stage IB (T1b): <0.8 with ulceration or 0.8–1 mm with no ulceration T1a with adverse features (high mitotic index≥2/mm2 [in setting or young age], LVI, or a combination) |
Discuss with patient and consider SLNB | Discuss with patient and consider (does not include T1a tumors with adverse features) | 5–10% |
| Stage IB (T2a) or II: >1 mm | Offer SLNB (unless non-mitogenic or older patients, with a lower probability of positive SLNB) | Recommended for T2 and T3 tumors For T4 tumors, may be recommended |
>10% |
SLN, sentinel lymph node; SLNB, sentinel lymph node biopsy; LVI, lymphovascular invasion; NCCN, National Comprehensive Cancer Network; ASCO, American Society of Clinical Oncology; SSO Society of Surgical Oncology.
If patient is unfit or unwilling to act based on SLNB findings, reasonable to forgo SLNB.
*
Adapted from the Cutaneous Melanoma NCCN Guidelines, Version 4.2020.105
**
Adapted from the ASCO and SSO clinical practice guideline update.140