Stage 1B Cutaneous Melanoma

Published Date: 19th July 2016

Publication Authors: Yao S, Brackley P

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Question: 

Sentinel Lymph Node Biopsy (SLNB) has been advocated as part of the diagnostic and prognostic process in the 2010 updated guidelines for management of cutaneous melanoma. However, there remains some discrepancy in practice across the UK regarding offering SLNB in patients with 1B melanoma (ulceration or mitotic rate ≥1/mm2).

Methods: 

Fifty-two plastic surgery units from the UK were identified and contacted via telephone and email. Responses were predominantly obtained from skin cancer specialist nurses and consultants interested in skin cancers.

Results: 

Of the 52 units surveyed, 40% provide a SLNB service within their trust. Of these, 71% offer the surgery to stage 1B patients with either ulceration or high mitotic rate. Specifically, 57% routinely offer SLNB to patients with stage 1B disease due to ulceration; and 62% to stage 1B disease due to a high mitotic rate.

Conclusion: 

Despite recommendations from the UK guidelines, variation in management of melanomas remains. The risk of a positive SLNB in <1 mm melanoma is quoted at between 5 and 10%. Further studies are therefore warranted to look at the relationship between SLNB outcomes and Stage 1B disease, to guide us in formulating a more united approach to patient management across the UK.

Yao, S and Brackley, P. (2013).  The UK sentinel lymph node biopsy service in stage 1B cutaneous melanoma . Journal of the German Society of Dermatology. 11 (Supplement S7), 32

Yao, S; Brackley, PTH. (2013).  The UK sentinel lymph node biopsy service in stage 1B cutaneous melanoma . European Journal of Cancer. 49 (Suppl 2), S865 

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