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Sentinel Lymph Node Biopsy for Cutaneous Melanoma of the Head and Neck

¹ Department of Laboratory Medicine and Pathobiology, Banting Institute, 100 College Street, Room 110, Toronto, Ontario, Canada M9G 1L5
² Department of Pathology and Laboratory Medicine, University Health Network, 620 University Avenue, Room 4-302, Toronto, Ontario, Canada M5G 2M9
³ Department of Surgery, University Health Network, 620 University Avenue, Third Floor, Room 3-130, Toronto, Ontario, Canada M5G 2M9

Correspondence: Address correspondence and reprint requests to: Karen Nicole MacNeill, MD; E-mail: karenmacneill{at}yahoo.com.

Background: Lymph node status is the most important prognostic factor for patients with cutaneous melanoma. Sentinel lymph node biopsy (SLNB) is now the standard of care for staging clinically node-negative patients. It is accurate with low morbidity, yet SLNB for head and neck melanoma is challenging because of unpredictable lymphatic drainage and risk of complications.

Methods: A retrospective analysis of prospectively collected data identified patients with cutaneous melanoma of the head and neck .76 mm. Sentinel lymph nodes were identified by using a standardized protocol of preoperative lymphoscintigrams, intraoperative blue dye injections, and handheld gamma probes. Clinical, surgical, and pathologic data were collected and analyzed.

Results: A sentinel lymph node was removed in 41 (94%) of 44 patients. Seven (17%) of 41 had at least 1 positive sentinel lymph node. Three of seven had primary tumors <1 mm (two of the three were not ulcerated). The sites of lymphatic drainage of the primary lesion were discordant, with historical anatomically predicted sites in 24.4% of cases. None of the 34 patients with negative SLNB has had a nodal recurrence (false-negative rate, 0%; sensitivity and negative predictive value, 100%). The mean follow-up is 22.4 months (range, <1–69 months). Seven (17%) of 41 patients had minor complications.

Conclusions:: SLNB in the head and neck area is challenging; however, combined pre-operative, intraoperative, and histological techniques produce a sensitive procedure with a high negative predictive value. The lack of false-negative results obviates the need for prophylactic neck dissections.

Key Words: Sentinel lymph node biopsy • Head and neck • Metastatic melanoma • Cutaneous