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Suspicious melanoma lesion — ABIM Board MCQ

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HardDermatologySuspicious melanoma lesionABIM Board

A 58-year-old man undergoes complete excisional biopsy of a melanoma on the back. Breslow thickness is 1.3 mm, there is no ulceration, and examination shows no palpable nodes or distant symptoms. Which staging procedure should be discussed next?

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Correct answer: A — Discuss sentinel lymph-node biopsy during definitive wide excision

The best answer is “Discuss sentinel lymph-node biopsy during definitive wide excision”. For clinically node-negative invasive melanoma of this thickness, sentinel lymph-node biopsy provides regional staging information and should be discussed with definitive wide excision. Absence of ulceration lowers risk but does not make nodal staging irrelevant at 1.3 mm. Routine PET-CT and serum markers have low yield in otherwise localized disease.

Reference: American Academy of Dermatology Melanoma Clinical Guideline: https://www.aad.org/member/clinical-quality/guidelines/melanoma