Cutaneous Melanoma · Margins + Sentinel Node

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Breslow thickness + ulceration/high-risk
   Breslow thickness? Ulceration/high-risk features?
   • In situ → In situ → margin 0.5–1 cm
   • Breslow ≤1 mm → ≤1 mm → margin 1 cm
   • Breslow 1–2 mm → 1–2 mm → margin 1–2 cm + sentinel node
   • Breslow >2 mm → >2 mm → margin 2 cm + sentinel node
2. [End] In situ → margin 0.5–1 cm
   Melanoma in situ → wide local excision with a 0.5–1 cm margin, down to the superficial fascia; sentinel lymph node biopsy generally not needed.
3. [End] ≤1 mm → margin 1 cm
   Breslow ≤1 mm → wide excision with a 1 cm margin; sentinel lymph node biopsy for ≥pT1b (≥0.8 mm or with ulceration/high-risk).
4. [End] 1–2 mm → margin 1–2 cm + sentinel node
   Breslow 1–2 mm → 1–2 cm margin; perform sentinel lymph node biopsy for staging.
5. [End] >2 mm → margin 2 cm + sentinel node
   Breslow >2 mm → 2 cm margin, down to fascia; sentinel lymph node biopsy; positive/high-risk consider adjuvant immunotherapy (PD-1)/targeted therapy.

Source guidelines & references

• Cutaneous melanoma surgical management (NCCN; NICE; margins by Breslow thickness)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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