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Alopecia Areata — SCE Dermatology MCQ

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HardHair DisordersAlopecia AreataSCE Dermatology

A completely excised 0.9-mm non-ulcerated melanoma has no lymphovascular invasion and a mitotic index of 1/mm². Examination shows no nodal or distant disease. What does NICE recommend about sentinel-node biopsy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Do not offer SLNB because the specified thin-melanoma risk features are absent

Explanation lettering: E = shown as C · C = shown as E

A is correct. NICE considers SLNB for a 0.8–1.0-mm melanoma only when ulceration, lymphovascular invasion or a mitotic index of at least 2 is present. None applies here, so SLNB is not offered on the stated findings. Imaging is not used as a gate before SLNB unless nodal or distant metastasis is suspected. Completion lymph-node dissection is not a substitute staging procedure. Breslow thickness is not mathematically adjusted for regression. The patient still requires appropriate wide excision, education and stage-based follow-up.

Reference: NICE NG14: melanoma assessment and management: https://www.nice.org.uk/guidance/ng14/chapter/recommendations