Abstract
Objective: Delineate clinico-pathologic factors associated with recurrence of cutaneous melanoma of the head and neck region and survival after negative sentinel lymph node biopsy (SLNB).
Method: A retrospective review from January 2000 to June 2009 was conducted at a tertiary referral center. Characteristics and outcomes of 204 patients with head and neck melanoma who underwent negative SLNB were analyzed in a univariant and multivariant fashion. Main outcomes measured included: local, regional, distant recurrences, and survival.
Results: A total of 204 patients with cutaneous melanoma of the head and neck underwent successful SLNB, in which final pathology was negative for nodal metastasis. Fifty-nine recurrences occurred in 42 patients: local/in-transit 18, regional 17, and distant metastasis 24. Five recurrences occurred within the same nodal basin that harbored the negative SLN(s). Decreased survival was associated with Breslow thickness (P < .05) and ulceration (P < .006). Local recurrence was associated with Clark level, Breslow thickness, and perineural invasion (P < .05). Regional recurrence was correlated with Breslow thickness (P < .05). Distant metastasis was associated with Breslow thickness, ulceration, nodular histology, and negative SLN(s) located in level V (P < .05).
Conclusion: Regional recurrence in a primary echelon nodal basin after negative SLNB is rare (2-4%) and is associated with increased Breslow thickness (>2.0mm). Thus, sentinel node biopsy is highly effective in assessing the draining nodal basin for metasatic disease and for directing further treatment leading to regional disease control.
Get full access to this article
View all access options for this article.