Sentinel lymph node biopsy (SLNB) is now used in multiple cancers. For cutaneous melanoma, what is the Breslow thickness threshold above which SLNB is routinely recommended according to current guidelines?
- A >1.0 mm ✓
- B >0.5 mm
- C >2.0 mm
- D >4.0 mm (T4 only)
Explanation
Current ASCO/SSO and European guidelines recommend SLNB for melanomas with Breslow thickness >1.0 mm (T2–T4). SLNB may also be considered for T1b melanomas (0.8–1.0 mm or with ulceration) in selected cases. For tumours ≤0.8 mm (T1a) without high-risk features, SLNB is generally not recommended as the sentinel node positivity rate is very low (<5%). SLNB provides important staging information, guides adjuvant therapy decisions, and identifies patients who may benefit from completion lymph node dissection or immunotherapy, though the MSLT-II trial showed completion dissection did not improve melanoma-specific survival.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.