Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update Journal Article


Authors: Wong, S. L.; Faries, M. B.; Kennedy, E. B.; Agarwala, S. S.; Akhurst, T. J.; Ariyan, C.; Balch, C. M.; Berman, B. S.; Cochran, A.; Delman, K. A.; Gorman, M.; Kirkwood, J. M.; Moncrieff, M. D.; Zager, J. S.; Lyman, G. H.
Article Title: Sentinel lymph node biopsy and management of regional lymph nodes in melanoma: American Society of Clinical Oncology and Society of Surgical Oncology clinical practice guideline update
Abstract: Purpose: To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. Methods: An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Results: Nine new observational studies, two systematic reviews, and an updated randomized controlled trial of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Recommendations: Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (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 risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of > 1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher-risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors and details of the reference patient populations are included within the guideline. © 2017 jointly by American Society of Clinical Oncology and Society of Surgical Oncology, as co-developers. All rights reserved.
Keywords: review; risk benefit analysis; cancer patient; lymph node dissection; sentinel lymph node biopsy; melanoma; tumor volume; practice guideline; high risk patient; systematic review; medical society; micrometastasis; low risk patient; human; priority journal
Journal Title: Journal of Clinical Oncology
Volume: 36
Issue: 4
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2018-02-01
Start Page: 399
End Page: 413
Language: English
DOI: 10.1200/jco.2017.75.7724
PROVIDER: scopus
PUBMED: 29232171
DOI/URL:
Notes: Review -- Export Date: 1 March 2018 -- Source: Scopus
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MSK Authors
  1. Charlotte Eielson Ariyan
    77 Ariyan