Primary Excision Margins and Sentinel Lymph Node Biopsy in Cutaneous Melanoma

Guideline Objective

To provide guidance on the optimal surgical excision margins and use of sentinel lymph node biopsy (SLNB) in adults diagnosed with cutaneous melanoma located on the trunk, extremities, and head and neck.

Patient Population

These recommendations apply to adults (>18 years) diagnosed with truncal, extremity, or head and neck non-metastatic cutaneous melanoma.

Intended Guideline Users

Intended users of this guideline include general surgeons, otolaryngologists, head and neck surgeons, surgical oncologists, dermatologists, and plastic surgeons that provide care for patients with melanoma. Additionally, all clinicians and healthcare providers who are involved in the management or referral of patients with cutaneous melanoma are intended users of these recommendations.

Research Questions

1. In patients with non-metastatic cutaneous melanoma with clinically node-negative or node-positive disease of the trunk or extremities, what are the optimal primary clinical margins of excision for melanoma?
2. In patients with distant metastases following a diagnosis of melanoma of the trunk or extremities, what are the optimal primary clinical margins of excision for cutaneous melanoma?
3. Should patients with clinically node-negative cutaneous melanoma of the trunk and extremities undergo SLNB for melanoma?
4. In patients with non-metastatic cutaneous melanoma with clinically node-negative or node-positive disease of the head and neck, what are the optimal primary margins of excision for melanoma?
5. In patients with distant metastases following a diagnosis of melanoma of the head and neck, what are the optimal primary margins of excision for cutaneous melanoma?
6. Should patients with clinically node-negative cutaneous melanoma of the head and neck undergo SLNB for melanoma?