Sentinel Lymph Node Biopsy for Melanoma
Based on guidelines from the American Society of Clinical Oncology and the Society of Surgical Oncology.
Sentinel Lymph Node (SLN) Biopsy
Thin Melanomas
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.
Moderate recommendation
Intermediate-thickness Melanomas
SLN biopsy is recommended for patients with melanomas that are T2 or T3 (Breslow thickness of >1.0 to 4.0 mm).
Moderate recommendation
Intermediate quality evidence
Thick Melanomas
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.
Moderate recommendation
Completion Lymph Node Dissection (CLND)
Completion Lymph Node Dissection
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.
Strong recommendation
What do the icons 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.
