Melanoma should be staged using the tumour, node, metastasis (TNM) staging classification described by the American Joint Committee on Cancer Staging Manual, 8th edition (AJCC8).
Click here for pathological reporting on therapeutic and sentinel lymph node dissection specimens.
Recommendation:
Good practice point: If there is palpable lymphadenopathy fine needle aspiration cytology should be used to obtain cytological confirmation of metastases, with ultrasound if required.
Good practice point: If open biopsy is undertaken the incision must be placed in the same line as for a potential radical lymphadenectomy.
Recommendation: Therapeutic lymph node dissection requires complete and radical removal of all draining lymph nodes to allow full pathological examination.
Good practice point: Patients with a confirmed metastatic lymph node(s) should be radiologically staged prior to lymph node dissection.
Good practice point: Regional lymph node dissection carries a well defined and significant morbidity and should be undertaken only by surgeons with appropriate expertise.
Good practice point: Patients should be advised of the risk of lymphoedema following lymph node dissection. If lymphoedema occurs, patients should be referred to a lymphoedema specialist.
Recommendation: Sentinel lymph node biopsy (SLNB) should be considered as a staging technique in patients with IB-IIC melanoma with a Breslow thickness of 1mm.
Recommendation: Consider sentinel lymph node biopsy for people who have melanoma with a Breslow thickness 0.8 mm to 1.0 mm and at least one of the following features:
Good practice point: While the above criteria have been shown to be the statistically significant thresholds for SLNB positivity in thin tumours, the likelihood of SLNB positivity in any individual is multifactorial. Outwith the above criteria, after consensus within the multidisciplinary team and careful discussion with the patient, SLNB may be considered in patients with thin melanomas (<1.0 mm) where the clinical team feel an individual patient’s risk merits the procedure.
Good practice point: Patients with resected stage IIB or IIC melanoma have the option of being considered for SLNB or proceeding directly to adjuvant immunotherapy, where appropriate. These patients should be discussed on an individual basis by the multidisciplinary team.
Recommendation: Completion lymphadenectomy is not recommended for the majority of patients.
Good practice point: There may be specific clinical cases where completion lymphadenectomy may be considered following multidisciplinary team discussion.
Cutaneous melanoma (SIGN)