When is sentinel lymph node biopsy (SLNB) discussed?
Sentinel lymph node biopsy (SLNB) is a staging procedure for selected patients with invasive melanoma. It helps determine whether microscopic melanoma is present in regional lymph nodes.
Three decision zones
Routine SLNB is generally not recommended.
SLNB may be discussed individually.
SLNB is generally actively discussed as part of staging.
This is a simplified patient-facing orientation, not an individual indication. The complete pathology report and clinical staging remain essential.
What else influences the decision
Pathology
Breslow thickness, ulceration and other features of the primary melanoma.
Clinical nodal status
SLNB is used when there are no clinically apparent metastatic lymph nodes. A suspicious node requires a different diagnostic pathway.
What the result means
Sentinel node negative
This lowers the likelihood that regional microscopic nodal disease was present at the time of surgery, but it does not reduce recurrence risk to zero.
Sentinel node positive
This confirms regional microscopic nodal involvement, changes pathological staging and can influence subsequent surveillance and systemic-treatment decisions.
Positive SLNB ≠ automatic complete lymph-node dissection
Subsequent management depends on stage, current guidance and multidisciplinary review.
Why the decision should be made before the next operation
If SLNB is indicated, it is generally best planned before or at the same time as wide local excision. Major tissue rearrangement or reconstruction can alter lymphatic drainage, so the sequence should be defined in advance.
Pathology
Breslow + ulceration.
Nodal assessment
Clinically negative or suspicious?
SLNB decision
Before definitive surgery.
WLE ± SLNB
One planned surgical stage.
Reviewed sources
This page explains how the decision is made. It does not determine an individual indication for SLNB without the complete pathology report and clinical staging.