Sentinel Lymph Node Biopsy for Melanoma

Based on guidelines from the American Society of Clinical Oncology and the Society of Surgical Oncology.

Strength

Evidence

Sentinel Lymph Node (SLN) Biopsy

Thin Melanomas

Moderate recommendation

Low-intermediate quality evidence

Routine SLN biopsy is not recommended for patients with melanomas that are T1a (nonulcerated lesions <0.8 mm in Breslow thickness). SLN biopsy may be considered for T1b patients (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risks of harm associated with the procedure.

Intermediate-thickness Melanomas

Moderate recommendation

Intermediate quality evidence

SLN biopsy is recommended for patients with melanomas that are T2 or T3 (Breslow thickness of >1.0 to 4.0 mm).

Thick Melanomas

Moderate recommendation

Low-intermediate quality evidence

SLN biopsy may be recommended for patients with melanomas that are T4 (>4.0 mm in Breslow thickness), after a thorough discussion with the patient of the potential benefits and risks of harm associated with the procedure.

Completion Lymph Node Dissection (CLND)

Completion Lymph Node Dissection

Strong recommendation

Intermediate-high quality evidence

Either CLND or careful observation may be offered to patients with low risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be offered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND.

Literature

Original/Primary Reference

Wong SL, Faries MB, Kennedy EB, et al. Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2018;36(4):399-413.

What do the ratings mean?

How strong is the ASCO's recommendation?

Strong recommendation

High confidence that recommendation reflects best practice, based on (1) strong evidence for true net effect (benefits > harms); (2) consistent results, with no or minor exceptions; (3) minor or no concerns about study quality; and/or (4) extent of panelists’ agreement.

Moderate recommendation

Moderate confidence that recommendation reflects best practice, based on (1) good evidence for true net effect (benefits > harms); (2) consistent results, with minor and/or few exceptions; (3) minor and/or few concerns about study quality; and/or (4) extent of panelists’ agreement.

Weak recommendation

Some confidence that recommendation offers the best current guidance for practice, based on (1) limited evidence for true net effect (benefits > harms); (2) consistent results, but with important exceptions; (3) concerns about study quality; and/or (4) extent of panelists’ agreement.

High quality evidence

High confidence that available evidence reflects true magnitude and direction of net effect (i.e., balance of benefits vs harms) and that further research is very unlikely to change either magnitude or direction of this net effect.

Intermediate-high quality evidence

Intermediate quality evidence

Moderate confidence that available evidence reflects true magnitude and direction of net effect. Further research is unlikely to alter the direction of the net effect; however, it might alter the magnitude of the net effect.

Low-intermediate quality evidence

Low quality evidence

Low confidence that available evidence reflects true magnitude and direction of the net effect. Further research may change either the magnitude and/or direction of this net effect.

Insufficient evidence

Evidence is insufficient to discern true magnitude and direction of net effect. Further research may better inform the topic. The use of the consensus opinion of experts is reasonable to inform outcomes related to the topic.