MSK Nomogram: Validated tool for predicting sentinel lymph node (SLN) positivity.
Pathology Inputs
Awaiting Findings
Enter the Breslow thickness and other pathology features to estimate the statistical probability of lymph node spread.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
Predicting the probability of sentinel lymph node (SLN) metastasis in clinically node-negative cutaneous melanoma.
Aiding in shared decision-making regarding whether to perform a Sentinel Lymph Node Biopsy (SLNBx).
Particularly useful for borderline cases (e.g., thin melanomas < 1 mm) where guidelines may be equivocal.
How it Works
Algorithm Variables
Age at diagnosis (older age inversely correlates with SLN positivity but directly correlates with poorer overall survival).
Tumor Location (Extremity vs. Trunk vs. Head/Neck).
Breslow Thickness (mm).
Ulceration (Present vs. Absent).
Mitotic Rate (included in updated nomogram versions).
Clinical Pearls
Clinical Pearls
The nomogram provides a localized, patient-specific percentage risk rather than generic population staging (e.g., AJCC groups).
A threshold of 5-10% predicted risk is typically the clinical threshold used by surgical oncologists to discuss or offer SLNBx.
The nomogram was shown to have better discrimination for SLN metastasis (concordance index of 0.71) than AJCC staging alone.
Next Steps
Surgical Planning
01
Predicted Risk < 5%: Standard wide local excision (WLE) alone is generally recommended. Clinical nodal surveillance is advised.
02
Predicted Risk 5-10%: Discuss the risks and benefits of SLNBx. Consider patient age, comorbidities, and preference.
03
Predicted Risk > 10%: Strongly recommend SLNBx concurrent with wide local excision.
The Evidence
Primary Reference
A nomogram that predicts the presence of sentinel node metastasis in melanoma with better discrimination than the American Joint Committee on Cancer staging system.
Wong SL et al. • Ann Surg Oncol.. 2005;12(4):282-8. Original derivation and validation of the MSKCC predictive model.
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Origins & History
The nomogram was developed by researchers at Memorial Sloan Kettering Cancer Center (MSKCC), utilizing a prospective database of thousands of melanoma patients, to individualize surgical planning beyond broad AJCC stage groupings.
Last Comprehensive Review: 2026-07-17