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Sentinel lymph node biopsy (SLNB) - London.

The most accurate staging test for T1b to T4 melanoma. Pre-operative lymphoscintigraphy identifies the sentinel node, and intra-operative blue dye and a gamma probe guide its excision. The result upstages around a quarter of patients and unlocks adjuvant immunotherapy.

A stethoscope on a clinical desk

Indicative cost

What private SLNB costs in London.

All-inclusive ranges across London melanoma units, covering lymphoscintigraphy, surgery, histology and reconstruction where needed.

In short

SLNB in London: £8,500–£14,000 all-inclusive, histology in 10 to 14 days.

Procedure Indicative range
Sentinel lymph node biopsy (all-inclusive) £8,500–£14,000
Melanoma consultation £250–£450
Pre-op lymphoscintigraphy Included
Follow-up review £200–£350

Ranges depend on the hospital, the surgeon and whether reconstruction is needed.

Where it is done

London melanoma units.

Royal Marsden Private Melanoma Unit, Chelsea and Westminster Private Skin Cancer, HCA The Wellington Plastic Surgery and Melanoma, University College London Hospital Private Skin Cancer, Cadogan Clinic Melanoma, Guy's and St Thomas' Private Melanoma.

  • Timing matters

    SLNB accuracy is highest when done at primary surgery or within 6 to 12 weeks.

  • Surgeon volume matters

    Melanoma-unit surgeons have lower false-negative rates and lower morbidity.

Who is eligible

When SLNB is the right staging step.

NICE NG14 recommends discussion from T1b upwards. Not indicated for in-situ or T1a under 0.8 mm without high-risk features.

  • T1b melanoma, ≥0.8 mm

    Thickness threshold per NICE NG14.

  • T1a with ulceration

    Or other high-risk features.

  • T2 to T4 melanoma

    Routine staging recommended.

  • Adjuvant therapy decisions

    Result guides pembrolizumab or nivolumab discussion.

  • BRAF-mutant staging

    Guides dabrafenib plus trametinib planning.

  • Delayed staging within 6–12 weeks

    Feasible if not done at primary excision.

Procedure options

Timing and basin approach.

A 2 to 3 cm incision in the axilla, groin or neck basin depending on where the primary drained.

  • Combined with wide local excision

    The standard approach at primary surgery.

  • Delayed SLNB

    Performed within 6 to 12 weeks of the primary excision.

  • Axillary basin

    For upper limb and truncal primaries.

  • Groin or neck basin

    For lower limb, head and neck primaries.

Risks and recovery

What to expect afterwards - honestly.

Most patients go home the same day or after one night, with the wound settled inside two to three weeks.

  • Seroma

    15 to 25 percent, usually settles with aspiration.

  • Lymphoedema

    5 to 10 percent, higher in groin dissections.

  • Sensory nerve damage

    Numbness near the biopsy scar is common.

  • Wound infection

    Under 5 percent, treated with oral antibiotics.

  • False-negative rate

    5 to 10 percent, mitigated by surveillance.

  • Anaesthetic risk

    Low, standard GA workup applies.

Reading your notes

Your histology report in four parts. Read the last one first.

Most positive nodes carry small deposits of 0.1 to 2 mm. The report notes number of positive nodes, size, location and extracapsular extension.

  1. 01 Header

    Indication and consent

    Primary melanoma stage, basin drained and consent recorded.

  2. 02 Findings

    Nodes retrieved

    Number of sentinel nodes, basin location and identification method.

  3. 03 Assessment

    Histology

    H&E, immunohistochemistry, size of metastasis and extracapsular extension.

  4. 04 Impression

    Stage and next step

    Upstaged to N1a to N3 or negative, and adjuvant plan.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Covered by UK private medical insurance when there is a specialist referral and a clear melanoma diagnosis.

Frequently asked

Common questions about SLNB.

  • Why is SLNB routine for T1b to T4 melanoma?

    It is the most accurate staging test, upstaging around 15 to 25 percent of patients to stage III and unlocking adjuvant immunotherapy which changes prognosis.

  • Is SLNB covered by private medical insurance?

    Yes with a specialist referral and melanoma histology. Bupa, AXA, Vitality, Aviva, WPA and Cigna cover the pathway as a single episode.

  • What is my lymphoedema risk?

    Around 5 to 10 percent overall, higher for groin than axillary basins. Rates are much lower than for full lymph node dissection, which the MSLT-II trial showed is no longer routinely needed.

  • Can SLNB be done after my primary excision?

    Yes, delayed SLNB within 6 to 12 weeks of the wide local excision is feasible and accurate when the primary scar and basin anatomy are preserved.

  • Do all melanomas need SLNB?

    No. In-situ melanoma and T1a lesions under 0.8 mm without high-risk features do not need staging. NICE NG14 recommends discussion from T1b upwards.

  • Is adjuvant therapy always needed if positive?

    Not always. Pembrolizumab, nivolumab or BRAF-targeted therapy are discussed at the melanoma MDT weighing recurrence risk, side-effect profile and your preferences.

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