American Academy of Dermatology

View all recommendations from this society

Released October 29, 2013; sources updated September 20, 2016, June 14, 2017, July 9, 2018 and June 20, 2019; Updated October 18, 2021

Don’t perform sentinel lymph node biopsy, or other diagnostic tests for the evaluation of early, thin melanoma because they do not improve survival.

Patients with early, thin melanoma, such as melanoma in situ, T1a melanoma, or T1b melanoma ≤ 0.5mm, have a very low risk of the cancer spreading to the lymph nodes or other parts in the body. Further, patients with early, thin melanoma have a 97 percent five-year survival rate which also indicates a low risk of the cancer spreading to other parts of the body. As such, the performance of sentinel lymph node biopsy is unnecessary.

Additionally, baseline blood tests and radiographic studies (e.g. chest radiographs, CT scans, and PET scans) are not the most accurate tests for the detection of cancer that is spreading as they have high false-positive rates. These tests have only shown benefit when performed as indicated for suspicious signs and symptoms based on the patient’s history and physical exam

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Dermatology (AAD) is strongly committed to dermatologists serving as effective stewards of limited health care resources by assisting patients in making informed health care decisions. As such, the AAD leadership created a workgroup to develop this list with specific skills and expertise in evidence based research, public health quality and payer policy. Members of this workgroup include dermatologists who are current members of the Academy’s Board of Directors, Council on Science and Research, Council on Government Affairs, Health Policy and Practice, Research Agenda Committee, Clinical Guidelines Committee, Access to Dermatology Care Committee, Patient Safety and Quality Committee, Resource-Based Relative Value Scale Committee and the Workgroup on Innovative Payment Delivery. The workgroup identified areas to be included on this list based on the greatest potential for overuse/misuse, quality improvement and availability of strong evidence based research as defined by the recommended criteria listed below. The recommended list was reviewed and approved by the AAD Council on Science and Research and the AAD Board of Directors.

  • Supported by available scientific evidence (e.g., existing AAD appropriate use criteria and/or existing AAD clinical guidelines)
  • Strongest consensus inappropriate score from the AAD Appropriate Use Criteria (AUC)
  • Strong (wording/level of evidence) recommendations from the guidelines about discouraged practice
  • Greatest potential for improvement in outcomes for patients
  • Greatest potential for overuse/misuse by physicians

AAD’s disclosure and conflict of interest policy can be found at www.aad.org.

Sources

Rosko AJ, Vankoevering KK, McLean SA, Johnson TM, Moyer JS. Contemporary management of early-stage melanoma: A systematic review. JAMA Facial Plast Surg. 2017;19:232-8.

Swetter, SM, Tsao H, Bichajkian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson JM, Sober AJ, Thompson JA, Wisco OJ, Wyat S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2019;80(1):208-50.

American Joint Committee on Cancer, AJCC Cancer Staging Manual, Eighth Edition: 2017.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Melanoma. (Version 3.2015).