There is a significant subset of primary cutaneous melanocytic neoplasms that are difficult to diagnose with the use of routine light microscopy. The currently recommended approach in assessing such lesions is to make a histopathologic diagnosis that reflects some uncertainty and then to recommend complete surgical excision. While adequate in many cases, the excision that might be recommended for such a lesion if malignant would be mutilating in many others. To increase the sensitivity of diagnosis and to provide potentially useful prognostic information, we propose that sentinel lymphadenectomy be considered in patients with melanocytic neoplasms of uncertain behavior that are 1.0 mm or more in thickness.
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