Lymph nodes are more likely to be affected by melanoma when tumor thickness is 0.75 millimeter or greater and sentinel lymph node biopsy should be performed in those cases, according to a retrospective, multicenter study published in the Journal of Clinical Oncology. Ulceration and a Clark level of 4 or greater were also predictive of metastasis. Mitotic rates of 1 square millimeter or more had no predictive value even in patients with thicker tumors, a finding that contradicted some other studies.

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