Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA.
J Clin Oncol. 2018 Feb 1;36(4):399-413. doi: 10.1200/JCO.2017.75.7724. Epub 2017 Dec 12.
Purpose To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. Methods An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Results Nine new observational studies, two systematic reviews, and an updated randomized controlled trial of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Recommendations Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (nonulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or < 0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of > 1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher-risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors and details of the reference patient populations are included within the guideline. Additional information is available at www.asco.org/melanoma-guidelines and www.asco.org/guidelineswiki .
目的 更新美国临床肿瘤学会（ASCO）-外科肿瘤学会（SSO）关于黑色素瘤前哨淋巴结（SLN）活检的指南。
方法 ASCO-SSO 小组成立，并对 SLN 活检和阳性前哨淋巴结后行淋巴结清扫术（CLND）的文献进行了系统回顾。
结果 纳入了 9 项新的观察性研究、2 项系统评价、一项 SLN 活检的更新随机对照试验，以及两项阳性 SLN 活检后行 CLND 的随机对照试验。
推荐意见 对于厚度为 T1a（非溃疡病变<0.8mm Breslow 厚度）的薄型黑色素瘤，不建议常规行 SLN 活检。对于厚度为 T1b（0.8 至 1.0mm Breslow 厚度或<0.8mm Breslow 厚度伴溃疡）的薄型黑色素瘤，在与患者充分讨论该操作的潜在获益和风险后，可考虑行 SLN 活检。对于中度厚度黑色素瘤（T2 或 T3；Breslow 厚度为>1.0 至 4.0mm），建议行 SLN 活检。对于厚度为 T4（Breslow 厚度>4.0mm）的黑色素瘤患者，在讨论潜在获益和风险后，可考虑行 SLN 活检。在前哨淋巴结活检阳性的情况下，对于低危微转移疾病患者，CLND 或密切观察是可选方案，应考虑临床病理因素。对于高危患者，仅在与患者充分讨论省略 CLND 的潜在风险和获益后，才可考虑密切观察。指南中包含了概述相关临床病理因素和参考患者人群详细信息的重要限定性说明。
额外信息可在 www.asco.org/melanoma-guidelines 和 www.asco.org/guidelineswiki 上获取。
