Sentinel Lymph Node Biopsy for Desmoplastic Melanoma: Not a Given

Abstract

Objective: 1) Determine the frequency of positive sentinel lymph node biopsy (SLNB) and characteristics predictive of positivity in a population of patients with desmoplastic melanoma of the head and neck. 2) Assess the utility of SLNB by determining the survival benefit and negative predictive value (NPV) of SLNB.

Method: Using the Surveillance, Epidemiology, and End Results (SEER) database, 467 patients with cutaneous desmoplastic melanoma of the head and neck were identified between 2003 and 2007 (years with reliable SLNB data). Frequency of nodal positivity, survival, and NPV of SLNB were determined.

Results: A total of 467 cases of desmoplastic melanoma were identified, of which most were locally advanced (mean Breslow depth 3.5 mm, 96% Clark level 4 or deeper). Few had regional lymph node metastases (3.4%) or distant spread (3.2%). A total of 165 patients had SLNB of which 4.8% had positive regional lymph nodes (NPV 98.5%). Breslow depth, ulceration, age, and sex were not predictive of positive SLNB. Patients who had SLNB did not have different disease-specific survival from those who did not undergo SLNB.

Conclusion: Despite the high accuracy of SLNB, this procedure should be undertaken with caution in patients with cutaneous desmoplastic melanoma of the head and neck, given the low propensity for lymphatic spread (3.4%), possibility of complications, and questionable disease-specific survival benefit.