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Melanoma Clinical Practice Guideline Update – January 2018

Author: SSO Staff
Jan 10, 2018

Sandra L. Wong, MD MS, SSO Treasurer, served as the lead author for the publication, “Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update” published in the December Online First edition of Annals of Surgical Oncology.

This publication was part of a continuing collaborative effort between ASCO and SSO to update the 2012 joint guideline. An expert panel was reconvened to address results from highly anticipated randomized controlled trials addressing the important question of regional nodal management following a positive sentinel lymph node biopsy. Two major recommendations were updated using a rigorous methodologic process including a systematic literature review.

The first recommendation addresses specific indications to assure appropriateness of SLN biopsy, noting the importance of avoiding overutilization of the procedure in patients with a very low likelihood of having regional nodal disease. Indications for sentinel lymph node biopsy to include intermediate thickness melanoma were affirmed. The guideline was updated to reflect changes in the AJCC staging system (8th edition) and while SLN biopsy for patients with thin melanoma classified as T1a is not recommended, SLN biopsy may be considered for T1b lesions (defined as 0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration).

Secondly, following a positive SLN biopsy, completion lymph node dissection (CLND) or careful observation may be considered for patients with low-risk micrometastatic disease. For higher risk patients, observation may be considered after discussion about the potential risks and benefits of foregoing CLND.  This second recommendation is very timely, taking new practice changing data into account and updating the prior guideline recommendation (which was to perform CLND when SLN biopsy is positive).

Dr. Wong stated, “We were gratified to be able to convene a group of melanoma experts to review new data in a timely fashion and allow the ASCO-SSO guideline to guide truly contemporary clinical practice.” Other SSO members on the expert panel include the following: Charlotte Ariyan, MD, Charles Balch, MD, Keith Delman, MD, Mark Faries, MD, Marc Moncrieff, MD, and Jonathan Zager, MD.

Access the full article at Annals of Surgical Oncology.

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