Sentinel lymph node biopsy now has a limited role in melanoma management

SLNB is confirmed as a prognostic test but does not influence melanoma-specific survival at 10 years. SLNB-negative patients still need regular review and can still die from their melanoma. SLNB-positive patients should be carefully counselled regarding the risks and very limited benefit (if any) of proceeding to CL. SLNB should not be regarded as essential or standard of care for patients with melanomas. SLNB should be discussed with patients with intermediate-thickness melanoma. Note that ‘discuss’ is not the same as ‘offer’ or ‘recommend’. The discussion should include: • SLNB does not alter survival prospects • SLNB provides added accuracy to survival prognostic figures−−70% vs. 90% for melanoma Breslow thickness of 1.2–3.5 mm • SLNB has a 10% complication rate • If positive, no added treatment can be offered that has demonstrated survival benefits−− this includes no apparent survival benefit in proceeding to CL−− SLNB-positive patients can be offered enrolment into further melanoma studies.