Recommendations

ASCO and the SSO developed the following recommendations on the use of SNB and lymph node dissection for melanoma:

• SNB is recommended for patients with a melanoma that developed on any part of the surface of the skin and is 1 millimeter (mm) to 4 mm thick.
• SNB may be recommended to help stage and determine treatment for a melanoma that is thicker than 4 mm.
• SNB is not recommended for most patients with a thin melanoma (less than 1 mm thick), although it may be considered if the melanoma has a high risk of spreading. It is not yet certain which patients with a thin melanoma have a higher risk of the disease spreading to the lymph nodes. However, some high-risk features of melanoma include ulceration (the outer layer of skin over the melanoma is missing when viewed under a microscope) or a high mitotic rate (more cells that are dividing; a sign that the cancer may be growing rapidly).

A lymph node dissection is recommended for all patients when melanoma is found in the sentinel lymph nodes.