title: Evidence-based clinical practice guidelines on the use of sentinel lymph node biopsy in melanoma.
abstract: Sentinel lymph node biopsy (SLNB) was introduced in 1992 to allow histopathologic evaluation of the "sentinel" node, that is, the first node along the lymphatic drainage pathway from the primary melanoma. This procedure has less risk of complications than a complete lymphadenectomy, and if the sentinel node is uninvolved by tumor the likelihood a complete lymphadenectomy would find metastatic disease in that nodal basin is very low. SLNB is now widely used worldwide in the staging of melanoma as well as breast and Merkel cell carcinomas. SLNB provides safe, reliable staging for patients with clinically node-negative melanomas 1 mm or greater in thickness, with an acceptably low rate of failure in the sentinel node-negative basin. Evidence-based guidelines jointly produced by ASCO and the Society of Surgical Oncology (SSO) recommend SLNB for patients with intermediate-thickness melanomas and also state that SLNB may be recommended for patients with thick melanomas. Major remaining areas of uncertainty include the indications for SLNB in patients with thin melanomas, pediatric patients, and patients with atypical melanocytic neoplasms; the optimal radiotracers and dyes for lymphatic mapping; and the necessity of complete lymphadenectomy in all sentinel node-positive patients.
authors.affiliation: From the Department of Cutaneous Oncology, Moffitt Cancer Center, and Departments of Oncologic Sciences and Surgery, University of South Florida, Tampa, FL; Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI; Departments of Surgical Oncology and Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX; Melanoma Institute Australia and the University of Sydney, Sydney, Australia.
authors.forename: Vernon K
authors.initials: VK
authors.lastname: Sondak
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
mesh_terms: D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008545:Melanoma / Q000556:secondary*; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy / Q000592:standards*; D012878:Skin Neoplasms / Q000473:pathology*