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Daniel G. Coit and Anthony J. Olszanski

, and presence or absence of microsatellitosis (an indicator of stage III disease). Pure desmoplasia, if present, is important, as pure desmoplastic melanomas rarely metastasize to regional nodes, and sentinel lymph node biopsy may not be necessary. A

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Robert H. I. Andtbacka and Jeffrey E. Gershenwald

patients: validation of the American Joint Committee on Cancer melanoma staging system . J Clin Oncol 2001 ; 19 : 3622 – 3634 . 5 Thompson JF Shaw HM . Is sentinel lymph node biopsy appropriate in patients with thin melanomas: too early to

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Stephen B. Edge and David G. Sheldon

-DeMore N Tan LK Liberman L . Sentinel lymph node biopsy: Is it indicated in patients with high-risk ductal carcinoma-in-situ and ductal carcinoma-in-situ with microinvasion? Ann Surg Oncol 2000 ; 7 : 636 – 642 . 4 McMasters KM Chao C Wong SL

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Hiram S. Cody III and Kimberly J. Van Zee

Surg 1995 ; 3 : 394 – 401 . 5 Temple LK Baron R Cody HS III . Sensory morbidity after sentinel lymph node biopsy and axillary dissection: A prospective study of 233 women . Ann Surg Oncol 2002 ; 9 : 654 – 662 . 6 Bedrosian I

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Tina J. Hieken, Mariana B. Sadurní, Enrica Quattrocchi, Ajdin Kobic, Sindhuja Sominidi-Damodaran, Lisette Meerstein, Jvalini T. Dwarkasing, Alina G. Bridges, and Alexander Meves

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Jason P. Wilson, David Mattson, and Stephen B. Edge

: 391 – 398 . 4. Lyman GH Giuliano AE Somerfield MR . American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early-stage breast cancer . J Clin Oncol 2005 ; 23 : 7703 – 7720 . 5. Kim HJ

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Benjamin E. Greer and Wui-Jin Koh

evaluation and sentinel lymph node biopsy (SLNB) or bilateral inguinofemoral lymph node dissection (LND). Lateral lesions should have ipsilateral groin node evaluation plus SLNB or ispsilateral groin LND. LND is performed through a separate incision, Dr

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Samuel W. Beenken and Marshall M. Urist

Merkel cell carcinoma (MCC) or neuroendocrine carcinoma of the skin is uncommon, often aggressive, and has a poor prognosis. Complete surgical excision with histologic documentation of clear resection margins is recommended for the primary cancer. Retrospective analysis of clinical data strongly suggests that adjuvant radiotherapy improves local control of MCC, but no evidence has been published that it prolongs survival. Sentinel lymph node biopsy is a useful method of determining the need for regional lymph node dissection in stage I patients. Chemotherapy regimens similar to those employed for small cell carcinoma of the lung have been recommended for advanced MCC. Patients often show an initial response to therapy, but it is usually short-lived. The three-year overall survival for patients with MCC is 31%. Before an improvement in long-term survival can be realized, early detection, appropriate use of surgery and radiation therapy, and the development of effective systemic chemotherapy are required.

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Anthony J. Olszanski

node; SLNB, sentinel lymph node biopsy; WLE, wide local excision. Data from Francken AB, Accortt NA, Shaw HM, et al. Follow-up schedules after treatment for malignant melanoma. Br J Surg 2008;95:1401–1407; Romano E, Scordo M, Dusza SW, et al. Site and

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Melanoma, Version 2.2013

Featured Updates to the NCCN Guidelines

Daniel G. Coit, Robert Andtbacka, Christopher J. Anker, Christopher K. Bichakjian, William E. Carson III, Adil Daud, Dominick DiMaio, Martin D. Fleming, Valerie Guild, Allan C. Halpern, F. Stephen Hodi Jr., Mark C. Kelley, Nikhil I. Khushalani, Ragini R. Kudchadkar, Julie R. Lange, Anne Lind, Mary C. Martini, Anthony J. Olszanski, Scott K. Pruitt, Merrick I. Ross, Susan M. Swetter, Kenneth K. Tanabe, John A. Thompson, Vijay Trisal, Marshall M. Urist, Nicole McMillian, and Maria Ho

localized lesions is excellent, the prognosis for advanced metastatic cases remains poor. Sentinel lymph node biopsy (SLNB) has emerged as an important staging tool that provides prognostic information. However, its clinical value in low-risk cases remains