Sandra L. Wong, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted a systematic review of the literature, from January 1990 through August 2011, to provide an evidence-based guideline on the use of lymphatic mapping and SLN biopsy in staging patients with newly diagnosed melanoma. The evidence was reviewed and recommendations were developed.

The researchers identified 73 studies that met the eligibility criteria. For most patients with newly diagnosed melanoma, SLN biopsy was found to be an acceptable method for lymph node staging. For any anatomic site, SLN biopsy was recommended for patients with intermediate-thickness melanomas and provided accurate staging; SLN biopsy may be recommended for staging purposes and to facilitate regional control of disease for patients with thick melanomas; for patients with thin melanomas there was insufficient evidence to support routine SLN biopsy, although it may be considered in patients with high-risk features. For patients with a positive SLN biopsy, completion lymph node dissection was recommended and achieved good regional control of disease.

"There is a need for future clinical trials to address many unresolved research questions related to the use of SLN biopsy in patients with melanoma," the authors write. "Answers to questions like these 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."

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