Using Sentinel Lymph Node Biopsy for Thick (>4 mm) Head and Neck Melanoma

Abstract

Objectives:

Sentinel lymph node biopsy (SLNB) has become standard practice for intermediate-thickness head and neck melanoma (HNM) but remains controversial for melanomas >4 mm thick. The objectives of this study were to evaluate the diagnostic accuracy and the prognostic value of SLNB in patients with thick HNM.

Methods:

Retrospective cohort study of patients undergoing SLNB for thick HNM at a large cancer center between June 2000 and December 2012. Univariate and multivariate analysis of prognostic factors was performed. False negative SLNB was defined as recurrence within a previously identified negative nodal basin.

Results:

A total of 107 patients with thick HNMs were identified, of which 77 met inclusion criteria. Population characteristics included a mean patient age of 62.9 (range 4-87) with a male predominance (82%). Mean Breslow thickness was 6.04 mm (range 4-21 mm). Of the 77 patients undergoing attempted SLNB, 7 had no identifiable SLN (9%). For the remaining 91% with identifiable SLN(s), the mean number of nodes identified was 3.3 (range 1-13). The SLN positivity rate was 24%. A false-negative SLNB occurred in two patients (3.8%). With a median follow-up of 36 months, the estimated 5-year disease-free, disease-specific and overall survival rates were 47%, 80%, and 71%, respectively. A positive SLN was significantly linked to shortened DFS (35% v. 51%, P = 0.028) and DSS (65% v. 85%, P = 0.04) and trended towards significance for OS (59% v. 76%, P = 0.09).

Conclusions:

SLNB provides accurate staging of the regional node basin and important prognostic information for patients with thick HNM.