(ChemotherapyAdvisor) – The American Society of Clinical Oncology (ASCO) and the Society of Surgical Oncology (SSO) issued an evidence-based clinical practice guideline on the use of lymphatic mapping and sentinel lymph node (SLN) biopsy in staging patients with newly diagnosed melanoma. The guideline appears in the Journal of Clinical Oncology online July 9.
An Expert Panel reviewed evidence from a comprehensive systematic review of the literature from January 1990 through August 2011 that identified 73 studies meeting full eligibility criteria; included were abstracts from ASCO and SSO annual meetings. Two clinical questions were addressed: “What are the indications for SLN biopsy?” and “What is the role of completion lymph node dissection (CLND)?”
Specifically, the guideline recommended SLN biopsy for patients with intermediate-thickness melanomas (Breslow thickness, 1 to 4 mm) of any anatomic site, as it provides accurate staging. For patients with thick melanomas (T4; Breslow thickness, >4 mm), SLN biopsy may be recommended for staging purposes and to facilitate regional disease control, despite few studies of this patient population.
Insufficient evidence supports routine SLN biopsy for patients with thin melanomas (T1; Breslow thickness, <1 mm), the guidelines state; however, “it may be considered in selected patients with high-risk features when staging benefits outweigh risks of the procedure.”
All patients with a positive SLN biopsy should undergo CLND, which has been found to achieve good regional disease control. “Whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II,” the article states.
The guideline also urges clinicians to discuss risks and benefits of SLN biopsy for melanoma with patients and to be aware of disparities in quality of care and access to care. Future clinical trials are needed to address several unresolved questions; answers “will assist clinicians and patients with making decisions and ultimately help to identify patients who may avoid expensive and intrusive procedures in staging and follow-up.”
Full guideline, clinical tools, and resources:
Information for patients: