Breslow Thickness & Melanoma Staging
Breslow thickness is the primary determinant of melanoma T-stage and sentinel lymph node biopsy eligibility. Based on AJCC 8th edition staging.
Score interpretation
Stage I: Localised, thin melanoma. 10-year survival > 90%.
→ Wide local excision (WLE): 1 cm margin for T1, 1–2 cm for T2. Sentinel lymph node biopsy (SLNB) considered if T1b or ≥ T2 (NICE NG14). Dermatology and/or plastic surgery referral. Dermoscopy surveillance annually. No adjuvant therapy routinely indicated for Stage I.
Stage II: Thicker localised melanoma without nodal involvement. 10-year survival 50–80%.
→ WLE: 2 cm margins. SLNB mandatory (T3–T4). If SLNB positive → Stage III management. Consider adjuvant immunotherapy (pembrolizumab or nivolumab) for Stage IIB/IIC. MDT discussion. Oncology referral. 3–6-monthly surveillance.
Stage III: Regional lymph node metastases. 10-year survival 30–60%.
→ Complete lymph node dissection or targeted therapy. Adjuvant therapy: anti-PD1 (pembrolizumab / nivolumab) or BRAF/MEK inhibitor (dabrafenib + trametinib) if BRAF V600E mutant. Molecular testing mandatory (BRAF, NRAS, c-KIT). Clinical trial enrolment if available.
Stage IV: Distant metastases. Median OS now ~3 years with modern immunotherapy.
→ Molecular testing (BRAF/MEK). First-line: ipilimumab + nivolumab (high response rate, significant toxicity) or pembrolizumab monotherapy. BRAF-mutant: dabrafenib + trametinib. Brain metastases: stereotactic radiosurgery ± systemic therapy. Palliative care involvement. Clinical trial.
Interpretation bands for the Breslow / Melanoma. Apply clinical judgement and local guidance.
References
- Gershenwald JE et al. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017.
- NICE NG14. Melanoma: assessment and management. 2015 (updated 2022).
Related
Curated clinical cross-links plus same-class fallbacks.
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- Psoriasis — Severity Assessment and Step-Up Therapy · NICE NG153 2019 / BAD
- Atopic Eczema — Assessment and Step-Up Therapy · NICE NG95 2023
- Urticaria and Angioedema · BSACI / EAACI Guidelines 2022
- Acne Vulgaris — Grading and Treatment · NICE NG198 2021 / BAD
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.