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Annals of Surgical Oncology 10:21-26 (2003)
© 2003 Society of Surgical Oncology

ORIGINAL ARTICLES

Sentinel Lymph Node Biopsy for Head and Neck Melanomas

Celia Chao, MD, Sandra L. Wong, MD, Michael J. Edwards, MD, Merrick I. Ross, MD, Douglas S. Reintgen, MD, R. Dirk Noyes, MD, Wayne K. Stadelmann, MD, Eric Lentsch, MD and Kelly M. McMasters, MD, PhD for the Sunbelt Melanoma Trial Group

From the Division of Surgical Oncology (KMM, CC, SLW, MJE), James Graham Brown Cancer Center, the Division of Otolaryngology-Head and Neck Surgery (EL), and the Division of Plastic and Reconstructive Surgery (WKS), University of Louisville, Louisville, Kentucky; University of Texas M. D. Anderson Cancer Center (MIR), Houston, Texas; LDS Hospital (RDN), Salt Lake City, Utah; and the University of South Florida (DSR), Moffitt Cancer Center, Tampa, Florida.

Correspondence: Address correspondence and reprint requests to: Kelly M. McMasters, MD, PhD, Division of Surgical Oncology, University of Louisville-Brown Cancer Center, 315 East Broadway, Suite 309, Louisville, KY 40202; Fax: 502-629-3393; E-mail: kelly.mcmasters{at}nortonhealthcare.org

Background: Sentinel lymph node (SLN) biopsy for head and neck (H&N) melanomas may be more technically challenging compared with other locations because of complex lymphatic drainage patterns. This analysis was performed to compare the results of SLN biopsy for H&N, truncal, and extremity melanomas.

Methods: The Sunbelt Melanoma Trial includes patients aged 18 to 70 with melanomas >=1.0 mm thick. Statistical comparison was performed by {chi}2 or analysis of variance test.

Results: A total of 2610 patients were evaluated with a median follow-up of 18 months. The mean number of SLN per nodal basin was 2.8, 2.7, and 2.1 for H&N, truncal, and extremity melanomas, respectively. Median Clark level, Breslow thickness, and percentage of ulceration were similar between the groups. Peri-parotid SLN was identified in 25% of cases; there were no facial nerve injuries. SLN biopsy for H&N melanoma had higher false-negative rates at 1.5% (vs. 0.5% for trunk or extremity) but less histologically positive SLN at 15% (vs. 23.4%, and 19.5%; P < .001) compared with truncal and extremity melanoma. Blue dye was visualized less frequently in SLN of H&N melanoma patients compared with those with trunk or extremity melanomas.

Conclusions: Preoperative lymphoscintigraphy and meticulous intraoperative search for blue/radioactive nodes may improve results in H&N melanomas.

Key Words: Head and neck melanoma • Sentinel lymph node • Recurrence • Lymphoscintigraphy • Nodal basins




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