Case 9 - Question 5 - Alberta Dermatology

You receive the pathology report within a couple days, and it reads:

Diagnosis: Acral lentiginous melanoma
Location: Right heel
Breslow thickness: 2.1 mm, however, this may not represent the greatest thickness of lesion due to incomplete biopsy
Clark level: 3
Ulceration: Indeterminate
Mitotic rate: 5/mm2
Satellite metastases: Not able to assess
Margins: Distance from invasive component to deep margin is 3.5 mm, peripheral margins are positive
Tumour stage: T3a

Given these results, you send off a referral to a general surgeon to for further management.

Welcome to your Case 9 – Question 5

5. At the general surgeon’s office, they decide whether they should do a sentinel lymph node biopsy (SLNB) for Mr. Singh. In which of the following scenarios would you NOT perform a SLNB?

A. A patient presents with a 1.4 mm thick melanoma with ulceration and no palpable lymph nodes.

B. A patient presents with a 2.3 mm thick melanoma without ulceration and two palpable axillary lymph nodes.

C. A patient presents with a 1.0 mm thick melanoma with ulceration and no palpable lymph nodes.

D. A patient presents with a 4.1 mm thick melanoma with ulceration and one variably palpable lymph node.

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