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Melanoma — SCE Dermatology MCQ

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ModerateSkin CancerMelanomaSCE Dermatology

A 55-year-old woman presents with a 4 mm Breslow thickness ulcerated melanoma on her left calf. Staging CT is negative. According to BAD guidelines, what excision margin and additional procedure should be discussed?

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Correct answer: E — 2 cm margin; sentinel lymph node biopsy

For melanoma >4 mm (pT4), BAD guidelines recommend 2 cm excision margins. Sentinel lymph node biopsy (SLNB) should be discussed for melanomas ≥0.8 mm with additional adverse features or ≥1.0 mm thickness, as it provides important prognostic staging information. If SLNB is positive, adjuvant systemic therapy (checkpoint inhibitors) may be offered per NICE guidance. Completion lymph node dissection is no longer routinely recommended following positive SLNB based on recent trial data. Interferon-alpha is no longer standard adjuvant therapy.

Reference: BAD 2017 Melanoma Guidelines; NICE NG14 2022