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.

Wide local excision surgery

Recommendation R 

  • Consider a clinical margin of at least 0.5 cm when excising stage 0 melanoma.
  • Offer excision with a clinical margin of at least 1 cm to people with stage I melanoma.
  • Offer excision with a clinical margin of at least 2 cm to people with stage II melanoma.

Management of palpable lymph nodes

Good practice point tickIf there is palpable lymphadenopathy fine needle aspiration cytology should be used to obtain cytological confirmation of metastases, with ultrasound if required.

Good practice point tickIf open biopsy is undertaken the incision must be placed in the same line as for a potential radical lymphadenectomy.

Recommendation RTherapeutic lymph node dissection requires complete and radical removal of all draining lymph nodes to allow full pathological examination.

Good practice point tickPatients with a confirmed metastatic lymph node(s) should be radiologically staged prior to lymph node dissection.

Good practice point tickRegional lymph node dissection carries a well defined and significant morbidity and should be undertaken only by surgeons with appropriate expertise.

Good practice point tickPatients should be advised of the risk of lymphoedema following lymph node dissection. If lymphoedema occurs, patients should be referred to a lymphoedema specialist.

Staging with sentinel lymph node biopsy

Recommendation RSentinel lymph node biopsy (SLNB) should be considered as a staging technique in patients with IB-IIC melanoma with a Breslow thickness of >1mm.

Recommendation RConsider 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:

  • ulceration
  • lymphovascular invasion
  • a mitotic index of 2 or more.

Good practice point tickWhile 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 tickPatients 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.

Completion lymphadenectomy

Recommendation RCompletion lymphadenectomy is not recommended for the majority of patients.

Good practice point tickThere may be specific clinical cases where completion lymphadenectomy may be considered following multidisciplinary team discussion.