The sentinel lymph node biopsy (SNB) approach has largely replaced elective lymph node dissection for clinically node-negative melanoma baselines. Following a positive SNB on histopathology, patients typically undergo complete lymph node dissection. Since its introduction in 1992, the management paradigm has shifted from routine comprehensive nodal dissection to SNB-guided decision-making. Research has extensively evaluated SNB-related variables, including subclinical features such as micro-metastases and macro-metastases, as well as tumor burden within the SNB. Additional lines of investigation have focused on the impact of the number of sentinel nodes identified, the count of positive non-sentinel lymph nodes, and the number of non-sentinel nodes excised. The literature encompasses diverse study designs assessing how these factors correlate with nodal disease burden and subsequent treatment pathways. Uncertainty remains in how SNB tumor burden and related metrics translate into long-term clinical outcomes beyond nodal status, and how variations in SNB technique or pathology assessment might influence reported results.
Since 1992, the surgical treatment for melanoma has substantially changed,1 and in clinically negative nodal basin, elective lymph node dissection has been overtaken by the sentinel node biopsy (SNB) followed by complete lymph node dissection in the case of positivity to SNB at the histopathological report. Many different studies have examined these methods, looking at specific subclinical features such as micro-metastases or macro-metastases,2 SNB tumour burden,3 number of SNBs, number of positive non-sentinel lymph nodes, and number of excised non-sentinel lymph nodes.