Primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in cutaneous melanoma: a clinical practice guideline.
Background
For patients who are diagnosed with early-stage cutaneous melanoma, the principal therapy is wide surgical excision of the primary tumour and assessment of lymph nodes. The purpose of the present guideline was to update the 2010 Cancer Care Ontario guideline on wide local excision margins and sentinel lymph node biopsy (slnb), including treatment of the positive sentinel node, for melanomas of the trunk, extremities, and head and neck.


Methods
Using Ovid, the medline and embase electronic databases were systematically searched for systematic reviews and primary literature evaluating narrow compared with wide excision margins and the use of slnb for melanoma of the truck and extremities and of the head and neck. Search timelines ran from 2010 through week 25 of 2017.


Results
Four systematic reviews were chosen for inclusion in the evidence base. Where systematic reviews were available, the search of the primary literature was conducted starting from the end date of the search in the reviews. Where systematic reviews were absent, the search for primary literature ran from 2010 forward. Of 1213 primary studies identified, 8 met the inclusion criteria. Two randomized controlled trials were used to inform the recommendation on completion lymph node dissection.Key updated recommendations include:■ Wide local excision margins should be 2 cm for melanomas of the trunk, extremities, and head and neck that exceed 2 mm in depth.■ slnb should be offered to patients with melanomas of the trunk, extremities, and head and neck that exceed 0.8 mm in depth.■ Patients with sentinel node metastasis should be considered for nodal observation with ultrasonography rather than for completion lymph node dissection.


Conclusions
Recommendations for primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in patients with cutaneous melanoma have been updated based on the current literature.
['Wright|F C|FC|', 'Souter|L H|LH|', 'Kellett|S|S|', 'Easson|A|A|', 'Murray|C|C|', 'Toye|J|J|', 'McCready|D|D|', 'Nessim|C|C|', 'Ghazarian|D|D|', 'Hong|N J Look|NJL|', 'Johnson|S|S|', 'Goldstein|D P|DP|', 'Petrella|T|T|', '|||']
D018572:Disease-Free Survival D019317:Evidence-Based Medicine D006801:Humans D008197:Lymph Node Excision D008207:Lymphatic Metastasis D000072662:Margins of Excision D008545:Melanoma D009864:Ontario D017410:Practice Guidelines as Topic D016032:Randomized Controlled Trials as Topic D021701:Sentinel Lymph Node Biopsy D012878:Skin Neoplasms D000078202:Systematic Reviews as Topic D016896:Treatment Outcome
margins sentinel lymph nodes completion lymph node dissection Melanoma practice guidelines wide excision margins melanoma in situ sentinel lymph node metastases