The sentinel lymph node biopsy (SLNB) threshold for melanoma is determined by Breslow thickness. In current guidelines, SLNB is ROUTINELY recommended for melanomas with Breslow thickness:

• A >0.5 mm
• B >0.8 mm (with ulceration or mitoses) or >1.0 mm ✓
• C >2.0 mm
• D >3.0 mm

Explanation

Current AJCC (8th edition) guidelines recommend SLNB for melanomas with Breslow thickness >1.0 mm (T2-T4) and consider it for T1b melanomas (0.8–1.0 mm with ulceration, or any T1 with mitotic rate ≥1/mm²). SLNB provides staging information and guides adjuvant therapy but does not independently improve overall survival in early-stage disease. A positive SLNB (>2% tumour deposit) qualifies for adjuvant anti-PD1 therapy (pembrolizumab/nivolumab) or BRAF-targeted therapy if BRAF V600E-mutated.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.