Sentinel lymph node biopsy (SLNB)

Lymphatic mapping and SLNB can be considered to assess the presence of occult metastases in the regional lymph nodes of patients with primary tumors measuring at least 0.8 mm thick. These procedures may identify individuals who can avoid regional lymph node dissection and individuals who may benefit from adjuvant therapy.[3,8-12]

To ensure accurate identification of the sentinel lymph node, lymphatic mapping and removal of the sentinel lymph node are performed during the same operation as the wide excision of the primary melanoma.

Multiple studies have demonstrated the diagnostic accuracy of SLNB, with false-negative rates of 0% to 2%.[8,12-17] If micrometastatic melanoma is detected, active surveillance with ultrasound of the draining nodal basin is an acceptable treatment recommendation that has widely replaced complete lymph node dissection (CLND).[18,19] A complete regional lymphadenectomy can be considered in select populations.