Sentinel Lymph Node Biopsy for Melanoma: ASCO and SSO Joint Clinical Practice Guideline

Published in Journal of Clinical Oncology, Vol 30, Issue 23 (August), 2012: 2912-2918
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 Mara Schuchter, Matias E. Valsecchi, Donald L. Weaver, Gary H. Lyman


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


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


73 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.


SLN biopsy is recommended for patients with intermediate-thickness melanomas (1-4mm Breslow thickness) of any anatomic site; use of SLN biopsy in this population provides accurate staging. While there are few studies focusing on patients with thick melanomas (T4; >4mm Breslow thickness), 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; <1mm Breslow thickness), although it may be considered in selected cases 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 following a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II.

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