How do you approach patients with polypoid/nodular melanoma for adjuvant therapy when Breslow depth is not available on pathology?  

If it is nodular, the depth of invasion (Breslow) starts from the outer edge of the lesion vertically down and perpendicular to the dermis, so most likely if polypoid, it will be at least 3 or 4 mm, thus T3 or T4. If ulcerated, T3b or T4b.

For uncertain cases like this, I would recommend a multidisciplinary discussion with your pathologist first. For melanoma, the actual tumor size is not indicative of its invasiveness/risk of lymph node metastases. Melanoma tumors with a more horizontal growth phase (i.e., superficial spreading melan...