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Skin: Sentinel node biopsy threshold by Breslow thickness

Free question published 24 October 2026

SkinSentinel node biopsy threshold by Breslow thickness

A 41-year-old man has a melanoma excised from his back reported as Breslow thickness 1.8 mm, non-ulcerated, with no clinical or radiological evidence of nodal disease. He is otherwise well and wants accurate staging. What is the most appropriate recommendation regarding nodal assessment?

  1. ADo not offer sentinel lymph node biopsy procedure because the tumour is documented as non-ulcerated on careful histopathological review
  2. BArrange whole-body PET-CT instead of sentinel node biopsy
  3. CConsider sentinel lymph node biopsy given Breslow thickness exceeds 1.0 mm
  4. DProceed directly to completion lymph node dissection
  5. EOffer prophylactic nodal basin radiotherapy

Why C is correct

NICE NG14 advises considering sentinel lymph node biopsy for melanoma with a Breslow thickness greater than 1.0 mm. This 1.8 mm tumour exceeds that threshold, so SLNB should be considered for staging and prognostic information irrespective of ulceration status.

And why the others are not

  • AIncorrect: SLNB is considered on the basis of Breslow thickness greater than 1.0 mm; ulceration is not required at this thickness.
  • BIncorrect: PET-CT is not a substitute for microscopic nodal staging by SLNB in clinically node-negative disease.
  • DIncorrect: completion dissection is not a staging procedure and is not indicated without a positive sentinel node.
  • EIncorrect: prophylactic nodal radiotherapy has no role in clinically node-negative melanoma.

Source NICE NG14 - Melanoma: assessment and management — National Institute for Health and Care Excellence. Melanoma: assessment and management. NICE guideline NG14. Published 29 July 2015, updated 2022.

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