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Sentinel lymph node biopsy has replaced elective lymph node dissection in the management of melanoma. It provides an exact staging method of the regional lymph basin and is associated with low morbidity. Patients who are found to have a positive sentinel lymph node can selectively undergo regional lymph node dissection. Sentinel lymph node biopsy also provides the means to stratify patients into homogeneous groups for adjuvant therapies. Sentinel lymph node involvement is regarded as an independent prognostic factor. The therapeutic value of subsequent surgical and medical therapies in patients with positive sentinel nodes is currently being investigated in clinical trials.