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ESSO 45 | Why sentinel lymph node biopsy should not be omitted in high-risk melanoma

Hesham Mohamed • 4 Nov 2026
ESSO 45
Melanoma Skin Cancer

Hesham Mohamed, MBBch, The Royal Marsden NHS Foundation Trust, London, UK, discusses current guidelines for sentinel lymph node biopsy in melanoma, noting that low-risk cases (1A) are typically excluded while higher-risk patients are offered the procedure more liberally. Dr Mohamed highlights a significant ongoing debate regarding patients with high-risk melanoma, where recent 2025 ESMO guidelines suggest omitting sentinel lymph node biopsy. Sentinel lymph node biopsy should not be omitted in the high-risk group, as accurate staging is critical for appropriate patient management and informed decision-making. This interview took place at the 2026 European Society of Surgical Oncology (ESSO) Annual Meeting in Madrid, Spain.

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Transcript

So, the guidelines currently for the low risk melanoma I give a very clear guidance for who to offer sentinel lymph node to...
So, the guidelines currently for the low risk melanoma I give a very clear guidance for who to offer sentinel lymph node to. So, 1A are usually excluded. And then when you go up, usually offer them a little bit more. The problem at the moment is there is a significant debate about the high-risk group specifically because the immunotherapies and the last ESMO guidelines in 2025 last year suggested that you can omit the sentinel-lymph node biopsy for the high risk group. But we still argue that there is a 30 % chance for patients having positive sentinel and lymph node on the high-risk group. This changes the prognosis of these patients, changes the kind of adjuvant treatment they will get, and changes the discussion with the patient as well. The patient being informed they are stage 2C or 2B, while they end up actually being 3C. So, the patient understanding for how their life would be and their survival overall is quite different. So we’re quite focusing on the high-risk group and that we probably should not still omit the sentinel and lymph node for this group at least.

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