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Melanoma — SCE Dermatology MCQ

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ModerateSkin CancerMelanomaSCE Dermatology

A 28-year-old woman is found to have a melanoma on her back with Breslow thickness 1.2 mm without ulceration. She has no palpable lymphadenopathy. Her dermatologist recommends sentinel lymph node biopsy. What is the primary purpose of SLNB in melanoma?

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Correct answer: D — Prognostic staging — to determine the nodal status for accurate staging and guide adjuvant therapy decisions

The correct answer is D, prognostic staging, to determine the nodal status for accurate staging and guide adjuvant therapy decisions. At Breslow thickness 1.2 mm without ulceration and no palpable nodes, this patient has clinically node-negative disease, and NICE guidance recommends offering SLNB as a staging rather than therapeutic procedure. Nodal status is the strongest prognostic factor after Breslow thickness, and a positive sentinel node upstages the patient to stage III, which determines eligibility for adjuvant anti-PD-1 immunotherapy or BRAF/MEK inhibition and informs surveillance intensity. NICE explicitly frames SLNB as staging information for the patient and clinician, not as an intervention that itself improves survival, since completion lymphadenectomy after a positive SLNB has not been shown to improve melanoma-specific survival over observation with nodal ultrasound.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions