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
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To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma.
An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma.
Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included.
Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of >1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors, and details of the reference patient populations are included within the guideline.
The Expert Panel thanks Jeffrey Kirshner, MD, Geoffrey Gibney, MD, and Jean Rene Clemenceau, MD, and the Clinical Practice Guidelines Committee for their thoughtful reviews and insightful comments on this guideline.
The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or www.ascopubs.org/jco/site/ifc. Sandra L. Wong: no relationship to disclose. Mark B. Faries: Consulting or Advisory Role: Immune Design, Delcath Systems, Novartis, Castle Biosciences. Erin B. Kennedy: No relationship to disclose. Sanjiv S. Agarwala: Travel, Accommodations, Expenses: MSD, Bristol-Myers Squibb. Timothy J. Akhurst: Employment: Intellerad (I), Stock or Other Ownership: Perkin Elmer (I). Charlotte Ariyan: Employment: Pfizer (I), Stock or Other Ownership: Pfizer (I). Charles M. Balch: Honoraria: Merck, Merck Sharp & Dohme, Consulting or Advisory Role: Merck, Travel, Accommodations, Expenses: Merck, Merck Sharp & Dohme. Barry S. Berman: Consulting or Advisory Role: Bristol-Myers Squibb, Bayer, Genentech, Alexion Pharmaceuticals, Axess Oncology. Alistair Cochran: No relationship to disclose. Keith A. Delman: No relationship to disclose. Mark Gorman: No relationship to disclose. John M. Kirkwood: Consulting or Advisory Role: Bristol-Myers Squibb, Novartis, Genentech/Roche, EMD Serono, Array BioPharma, Merck. Research Funding: Prometheus (Inst), Merck (Inst). Marc D. Moncrieff: No relationship to disclose. Jonathan S. Zager: Honoraria: Amgen, Consulting or Advisory Role: Amgen, Castle Biosciences, Delcath Systems, Speakers’ Bureau: Amgen, Research Funding: Amgen (Inst), Castle Biosciences (Inst), Delcath Systems (Inst), Provectus (Inst). Travel, Accommodations, Expenses: Amgen. Gary H. Lyman: Consulting or Advisory Role: Halozyme, G1 Therapeutics, Coherus Biosciences. Research Funding: Amgen (Inst)
- 1.American Cancer Society: Cancer facts and figures 2017. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf
- 2.American Cancer Society: key statistics for melanoma skin cancer. https://www.cancer.org/cancer/melanoma-skin-cancer/about/key-statistics.html
- 9.Shiffman RN, Michel G, Rosenfeld RM, et al: Building better guidelines with BRIDGE-Wiz: development and evaluation of a software assistant to promote clarity, transparency, and implementability. J Am Med Inform Assoc. 19:94-101, 2012. https://doi.org/10.1136/amiajnl-2011-000172 CrossRefPubMedGoogle Scholar
- 10.Shojania KG, Sampson M, Ansari MT, et al: How quickly do systematic reviews go out of date? A survival analysis. Ann Intern Med. 147:224-233, 2007. https://doi.org/10.7326/0003-4819-147-4-200708210-00179 CrossRefPubMedGoogle Scholar
- 15.Sperry SM, Charlton ME, Pagedar NA: Association of sentinel lymph node biopsy with survival for head and neck melanoma: survival analysis using the SEER database. JAMA Otolaryngol Head Neck Surg. 140:1101-1109, 2014. https://doi.org/10.1001/jamaoto.2014.2530 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.van der Ploeg AP, Haydu LE, Spillane AJ, et al: Outcome following sentinel node biopsy plus wide local excision versus wide local excision only for primary cutaneous melanoma: analysis of 5840 patients treated at a single institution. Ann Surg. 260:149-157, 2014. https://doi.org/10.1097/SLA.0000000000000500 CrossRefPubMedGoogle Scholar
- 18.Kirkland EB, Zitelli JA: Mitotic rate for thin melanomas: should a single mitotic figure warrant a sentinel lymph node biopsy? Dermatol Surg. 40:937-945, 2014. https://doi.org/10.1097/01.DSS.0000452619.94264.ff CrossRefPubMedGoogle Scholar
- 21.Balch CM, Thompson JF, Gershenwald JE, et al: Age as a predictor of sentinel node metastasis among patients with localized melanoma: an inverse correlation of melanoma mortality and incidence of sentinel node metastasis among young and old patients. Ann Surg Oncol. 21:1075-1081, 2014. https://doi.org/10.1245/s10434-013-3464-x CrossRefPubMedPubMedCentralGoogle Scholar
- 23.The Cochrane Collaboration: Part 12.2 Assessing the quality of a body of evidence, in Higgins JPT, Green S (eds): Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0, March 2011. http://handbook-5-1.cochrane.org/
- 24.Kyrgidis A, Tzellos T, Mocellin S, et al: Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma. Cochrane Database Syst Rev. 5:CD010307, 2015.Google Scholar
- 26.Leiter U, Stadler R, Mauch C, et al: Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 17:757-767, 2016. https://doi.org/10.1016/S1470-2045(16)00141-8 CrossRefPubMedGoogle Scholar
- 29.Cigna E, Gradilone A, Ribuffo D, et al: Morbidity of selective lymph node biopsy for melanoma: meta-analysis of complications. Tumori. 98:94-98, 2012Google Scholar
- 34.US Cancer Statistics Working Group: United States cancer statistics: 1999–2012 incidence and mortality web-based report.www.cdc.gov/uscs
- 35.Howlader N, Noone AM, Krapcho M, et al: SEER cancer statistics review, 1975-2013. http://seer.cancer.gov/csr/1975_2013
- 36.Mead H, Cartwright-Smith L, Jones K, et al: Racial and Ethnic Disparities in U.S. Health Care: A Chartbook. New York, NY, The Commonwealth Fund, 2008Google Scholar
- 37.American Cancer Society: Cancer facts and figures for African Americans 2016-2018. http://www.cancer.org/acs/groups/content/@editorial/documents/document/acspc-047403.pdf
- 39.Streeter SB, Schwartzberg L, Husain N, et al: Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions. J Oncol Pract. 746s-51s, 2011(3, suppl). https://doi.org/10.1200/JOP.2011.000316
- 42.Andersen BL, DeRubeis RJ, Berman BS, et al: Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol. 32:1605-1619, 2014. https://doi.org/10.1200/JCO.2013.52.4611 CrossRefPubMedPubMedCentralGoogle Scholar