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We hypothesized that sentinel node biopsy is an effective staging strategy for this rare disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov decision model was constructed to represent two management strategies for SDM: wide local excision followed by observation, and wide local excision followed by sentinel node biopsy. Utilities, likelihood of positive sentinel node biopsy, and cancer progression rates during a five year time horizon were assigned based on institutional data and a review of existing literature. Estimated costs were derived using Medicare reimbursements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Excision followed by sentinel node biopsy provides greater utility, yielding 3.85 discounted quality\u2010adjusted life years (dQALY) compared to 3.66 for excision alone. The incremental cost\u2010effectiveness ratio for sentinel node biopsy is $19,102 per dQALY. Sensitivity analyzes demonstrated that observation is more cost\u2010effective if greater than 23% of sentinel node biopsies are positive (16% reported), or if 5\u2010year survival for observed patients is greater than 76% (69% reported).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Based on existing clinical evidence, sentinel node biopsy yields greater utility than excision alone and is cost\u2010effective for patients presenting with solitary dermal melanoma. <jats:italic>J. Surg. 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