Summary Background Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post‐operative follow‐up of 150 patients. Patients and Methods We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post‐operative complications and patients’ satisfaction after SLNB under TLA. Results 32 % of the patients reported post‐operative pain within the first 48 h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3 % of the patients. 98.7 % of the patients were satisfied with SLNB under TLA. Conclusions SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.