Sentinel Lymph Node Biopsy for Melanoma: Society of Surgical Oncology and American Society of Clinical Oncology Joint Clinical Practice Guideline

Editorial: "The Challenge of Defining Guidelines for Sentinel Lymph Node Biopsy in Patients with Thin Primary Cutaneous Melanomas" - JE Gershenwald, MD, DG Coit, MD, VK Sondak, MD and JF Thompson, MD (Editorial published in Annals of Surgical Oncology)

Executive Summary published in Annals of Surgical Oncology | Guideline Full Text (PDF)
Guideline Appendix Only (PDF) | Guideline Supplemental Data (PDF) | Bottom Line (PDF)

Published online July 9, 2012 in the Annals of Surgical Oncology and the Journal of Clinical Oncology.

By Sandra L. Wong, Charles M. Balch, Patricia Hurley, Sanjiv S. Agarwala, Timothy J. Akhurst, Alistair Cochran, Janice N. Cormier, Mark Gorman, Theodore Y. Kim, Kelly M. McMasters, R. Dirk Noyes, Lynn M. Schuchter, Matias E. Valsecchi, Donald L. Weaver, and Gary H. Lyman

Purpose: The Society of Surgical Oncology (SSO) and the American Society of Clinical Oncology (ASCO) sought to provide an evidence-based guideline on the use of lymphatic mapping and sentinel lymph node (SLN) biopsy in staging patients with newly diagnosed melanoma.

Methods: A comprehensive systematic review of the literature published from January 1990 through August 2011 was completed using MEDLINE and EMBASE. Abstracts from SSO and ASCO annual meetings were included in the evidence review. An Expert Panel was convened to review the evidence and develop guideline recommendations.

Results: Seventy-three studies met full eligibility criteria. The evidence review demonstrated that SLN biopsy is an acceptable method for lymph node staging of most patients with newly diagnosed melanoma.

Recommendations: SLN biopsy is recommended for patients with intermediate-thickness melanomas (Breslow thickness, 1 to 4 mm) of any anatomic site; use of SLN biopsy in this population provides accurate staging. Although there are few studies focusing on patients with thick melanomas (T4; Breslow thickness, > 4 mm), SLN biopsy may be recommended for staging purposes and to facilitate regional disease control. 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 staging benefits outweigh risks of the procedure. Completion lymph node dissection (CLND) is recommended for all patients with a positive SLN biopsy and achieves good regional disease control. Whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II.

The guideline endorsement is not intended to substitute for the independent professional judgment of the treating physician. Practice guidelines and endorsements do not account for individual variation among patients and may not reflect the most recent evidence. The guideline endorsement does not recommend any particular product or course of medical treatment. Use of the guideline endorsement is voluntary.