Annals of Surgical Oncology

, Volume 19, Issue 11, pp 3313–3324 | Cite as

Sentinel Lymph Node Biopsy for Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Joint Clinical Practice Guideline

  • Sandra L. Wong
  • Charles M. Balch
  • Patricia Hurley
  • Sanjiv S. Agarwala
  • Timothy J. Akhurst
  • Alistair Cochran
  • Janice N. Cormier
  • Mark Gorman
  • Theodore Y. Kim
  • Kelly M. McMasters
  • R. Dirk  Noyes
  • Lynn M. Schuchter
  • Matias E. Valsecchi
  • Donald L. Weaver
  • Gary H. Lyman
SSO Special Article



The American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) sought to provide an evidence-based guideline on the use of lymphatic mapping and sentinel lymph node (SLN) biopsy in staging patients with newly diagnosed melanoma.


A comprehensive systematic review of the literature published from January 1990 through August 2011 was completed using MEDLINE and EMBASE. Abstracts from ASCO and SSO annual meetings were included in the evidence review. An Expert Panel was convened to review the evidence and develop guideline recommendations.


Seventy-three studies met full eligibility criteria. The evidence review demonstrated that SLN biopsy is an acceptable method for lymph node staging of most patients with newly diagnosed melanoma.


SLN biopsy is recommended for patients with intermediate-thickness melanomas (Breslow thickness, 1–4 mm) of any anatomic site; use of SLN biopsy in this population provides accurate staging. Although there are few studies focusing on patients with thick melanomas (T4; Breslow thickness, >4 mm), SLN biopsy may be recommended for staging purposes and to facilitate regional disease control. There is insufficient evidence to support routine SLN biopsy for patients with thin melanomas (T1; Breslow thickness, <1 mm), although it may be considered in selected patients with high-risk features when staging benefits outweigh risks of the procedure. Completion lymph node dissection (CLND) is recommended for all patients with a positive SLN biopsy and achieves good regional disease control. Whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II.

Copyright © 2012 American Society of Clinical Oncology and Society of Surgical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology and Society of Surgical Oncology.



We thank the following for their thoughtful reviews of earlier drafts of the guideline: David E. Elder, MB, ChB, Andrew Spillane, B Med Sci, BMBS, MD, Christopher D. Lao, MD, MPH, and John F. Thompson, MBBS, BSc (Med), MD, and the American Society of Clinical Oncology Clinical Practice Guidelines Committee, Society of Surgical Oncology (SSO) Melanoma Disease Site Work Group, and SSO Executive Council.


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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Sandra L. Wong
    • 1
  • Charles M. Balch
    • 2
  • Patricia Hurley
    • 4
  • Sanjiv S. Agarwala
    • 5
  • Timothy J. Akhurst
    • 8
  • Alistair Cochran
    • 9
  • Janice N. Cormier
    • 3
  • Mark Gorman
    • 10
  • Theodore Y. Kim
    • 11
  • Kelly M. McMasters
    • 12
  • R. Dirk  Noyes
    • 13
  • Lynn M. Schuchter
    • 6
  • Matias E. Valsecchi
    • 7
  • Donald L. Weaver
    • 14
  • Gary H. Lyman
    • 15
  1. 1.University of MichiganAnn ArborUSA
  2. 2.University of Texas SouthwesternDallasUSA
  3. 3.University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.American Society of Clinical OncologyAlexandriaUSA
  5. 5.St Luke’s Cancer CenterBethlehemUSA
  6. 6.University of PennsylvaniaPhiladelphiaUSA
  7. 7.Thomas Jefferson UniversityPhiladelphiaUSA
  8. 8.Peter MacCallum Cancer InstituteMelbourneAustralia
  9. 9.University of California at Los Angeles Center for Health ServicesLos AngelesUSA
  10. 10.National Coalition for Cancer SurvivorshipSilver SpringUSA
  11. 11.Skagit Valley Regional Cancer CenterMount VernonUSA
  12. 12.University of LouisvilleLouisvilleUSA
  13. 13.Huntsman Cancer InstituteSalt Lake CityUSA
  14. 14.University of Vermont College of MedicineBurlingtonUSA
  15. 15.Duke UniversityDurhamUSA

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