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There is still controversy over the role of sentinel lymph node biopsy, if any, in the management of melanoma. A frequent indication for sentinel lymph node biopsy (SLNB) is melanoma with Breslow tumour thickness greater than 1.0 mm. There have rarely been any guidelines for thin melanomas with Breslow tumour thickness less than 1.0 mm, probably because of the low incidence of lymph node metastasis. This paper addresses the issue of thin melanomas and possible prognostic factors that might influence the need for SLNB. In this Japanese study 66 patients with thin melanomas were analyzed with regard to tumour thickness, mitotic index, tumour infiltrating lymphocytes (TIL), tumour size, regional lymph node metastases, Clark level and ultimate prognosis. There were higher frequencies of lymph node metastases in thin melanomas with two or more mitoses per square millimeter per high powered field, intensive TIL that partially or completely surrounded the tumours, Clark Level II or higher and an area of greater than 2.0 cm. The authors concluded that increased mitotic activity, large tumour size and an intense TIL may warrant consideration for SLNB in thin melanomas.