ASO Author Reflections: Role of Sentinel Lymph Node Biopsy in T1b Melanoma

Excerpt

Sentinel lymph node biopsy (SLNB) has been a mainstay of melanoma staging since its widespread and rapid adoption in the 1990s.1 Prior to the MSLT-II trial, SLNB had two main roles: it provided prognostic information and guided subsequent therapy. Patients who had a positive sentinel node were usually offered a completion lymph node dissection (CLND), and some were considered for adjuvant therapy. After MSLT-II, melanoma surgeons have moved away from CLND in favor of node basin surveillance for SLN-positive patients. The role of SLNB to select patients for adjuvant therapy also remains controversial, particularly for otherwise low-risk patients. Thin melanomas (≤ 1 mm Breslow thickness) generally carry an excellent prognosis and a low incidence of node metastases. However, those that are ulcerated or > 0.8 mm in Breslow thickness (T1b) have a sentinel node positivity risk of 5–10%.2 There is general agreement that SLNB is not required for patients with T1a melanoma, and practice patterns vary for patients with T1b disease. The key question is, given that SLNB rarely alters treatment in patients with T1b melanoma, does its prognostic value justify its costs and potential morbidity? …