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Melanoma comprises less than 3% of all cancers seen in children. Sentinel lymph node biopsy (SLNBX) is an important predictor of outcome in adult melanoma and has not been widely used in pediatrics. Furthermore, adjuvant interferon has only been rarely used in childhood high-risk disease.To review our experience with high-risk melanoma, the feasibility of SLNBX and the tolerance of high-dose interferon (HDI) therapy.We retrospectively reviewed the medical records of patients with the diagnosis of cutaneous melanoma at our center over a 10-year period.Eleven patients were identified (median age of 12 y). Six of 10 patients who underwent SLNBX had disease in the lymph nodes and no complications from this procedure were observed. After complete lymph node dissection in these 6 patients, 1 developed wound infection and 2 had chronic lymph edema. Five patients were treated with adjuvant HDI of whom 2 patients required dose modification due to myelosuppression and liver toxicity. After a median follow-up of 26 months, 10 out of 11 patients are in remission.SLNBX is feasible and safe in pediatric melanoma and offers the potential to identify patients at high risk for disease progression who could benefit from HDI.