Quality statement 6: Sentinel lymph node biopsy

Quality statement

People with stage IB–IIC melanoma with a Breslow thickness of more than 1 mm have a discussion about the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure.

Rationale

Sentinel lymph node biopsy helps to find out whether cancer has spread to the lymph nodes. It is better than ultrasound scans at finding very small deposits of cancers in the lymph nodes. However, it is not a form of treatment and, as with all invasive procedures, it has associated risks and complications that should be discussed with the person to enable shared decision making.

Quality measures

Structure

Evidence of local arrangements and clinical protocols to ensure that the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure are discussed with people with stage IB–IIC melanoma with a Breslow thickness of more than 1 mm.

Data source: Local data collection.

Process

Proportion of people with stage IB–IIC melanoma with a Breslow thickness of more than 1 mm who have a discussion about the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure.

Numerator – number in the denominator who have a discussion about the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure.

Denominator – number of people with stage IB–IIC melanoma with a Breslow thickness of more than 1 mm.

Data source: Local data collection.

Outcome

Satisfaction with support received when deciding the best treatment, reported by people with skin cancer.

Data source : Quality Health National Cancer Patient Experience Survey.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary and tertiary care) ensure that systems are in place for people with stage IB–IIC melanoma with a Breslow thickness of more than 1 mm to have a discussion about the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure.

Healthcare professionals (members of local hospital skin cancer multidisciplinary teams or specialist skin cancer multidisciplinary teams) discuss the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure with people who have stage IB–IIC melanoma with a Breslow thickness of more than 1 mm.

Commissioners (clinical commissioning groups and NHS England) ensure that in the services they commission the advantages and disadvantages of sentinel lymph node biopsy as a staging procedure are discussed with people who have stage IB–IIC melanoma with a Breslow thickness of more than 1 mm.

What the quality statement means for patients and carers

People with a type of skin cancer called malignant melanoma that is classified as stage 1B or stage 2 discuss the pros and cons of a procedure called sentinel lymph node biopsy with their healthcare professional. In this procedure, 1 or 2 lymph nodes near the cancer are removed and checked to see whether there is melanoma in them. Sentinel lymph node biopsy does not cure melanoma, but it can help to find out whether it has spread and may lead to other treatment options.

Source guidance