Drainage Patterns to Nontraditional Nodal Regions and Level IIB in Cutaneous Head and Neck Malignancy

Abstract

Objectives

(1) Determine the frequency of nontraditional sentinel lymph node (SLN) locations in cutaneous head and neck malignancy and (2) determine the frequency of level IIB SLNs in cutaneous head and neck malignancy.

Design

Case series with chart review.

Setting

Tertiary academic hospital.

Subjects and Methods

In total, 145 consecutive sentinel lymph node biopsy (SLNB) specimens for cutaneous head and neck malignancies were reviewed from 2007 to 2015. Nodal regions were categorized into levels I to V, parotid, external jugular (EJ), perifacial, suboccipital, and postauricular regions. Primary locations were divided into scalp, forehead, cheek, ear, neck, nose, periocular, and lip. Frequencies of sentinel lymph node (SLN) locations for each primary location were determined.

Results

Parotid, EJ, perifacial, suboccipital, postauricular, and level IIB lymph SLNs were identified as nontraditional lymph node regions at risk in head and neck cutaneous malignancy. EJ SLNs were present in over 15% of all cases and over 25% of periocular and cheek lesions. Perifacial SLNs were frequently present in nose and lip lesions. Suboccipital and postauricular nodes were only present in scalp lesions. Level II was the most common location for a SLN. In total, 15.9% of all cases involved level IIB. Scalp and ear primary lesions were most likely to drain to level IIB.

Conclusions

Nontraditional SLN locations, such as EJ, perifacial, suboccipital, postauricular, and parotid, as well as level IIB, are important sites of drainage for head and neck cutaneous malignancy. Prediction of at-risk lymph node regions is important to help guide SLNBs, elective and completion neck lymphadenectomy and radiation, and long-term observation.

Keywords

cutaneous head and neck malignancy lymphatic drainage patterns sentinel lymph node biopsy

Get full access to this article

View all access options for this article.

References

Wang

Myers

JN.

Pathways for cervical metastasis in malignant neoplasms of the head and neck region. Clin Anat. 2012;25:54-71.

Werner

Dunne

Myers

JN.

Functional anatomy of the lymphatic drainage system of the upper aerodigestive tract and its role in metastasis of squamous cell carcinoma. Head Neck. 2003;25:322-332.

Wiener

Uren

Thompson

JF.

Lymphatic drainage patterns from primary cutaneous tumours of the forehead: refining the recommendations for selective neck dissection. J Plast Reconstr Aesthetic Surg. 2014;67:1038-1044.

Fincher

O’Brien

McCarty

. Patterns of drainage and recurrence following sentinel lymph node biopsy for cutaneous melanoma of the head and neck. Arch Otolaryngol Head Neck Surg. 2004;130:844-848.

Lim

Tatla

Hersh

Hungerford

Patterns of regional head and neck lymph node metastasis in primary conjunctival malignant melanoma. Br J Ophthalmol. 2006;90:1468-1471.

O’Brien

Uren

Thompson

. Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy. Am J Surg. 1995;170:461-466.

Pan

W-R

Le Roux

Briggs

CA.

Variations in the lymphatic drainage pattern of the head and neck: further anatomic studies and clinical implications. Plast Reconstr Surg. 2011;127:611-620.

Pathak

O’Brien

Petersen-Schaeffer

. Do nodal metastases from cutaneous melanoma of the head and neck follow a clinically predictable pattern? Head Neck. 2001;23:785-790.

Shah

Kraus

Dubner

Sarkar

Patterns of regional lymph node metastases from cutaneous melanomas of the head and neck. Am J Surg. 1991;162:320-323.

10.

Wanebo

Harpole

Teates

CD.

Radionuclide lymphoscintigraphy with technetium 99m antimony sulfide colloid to identify lymphatic drainage of cutaneous melanoma at ambiguous sites in the head and neck and trunk. Cancer. 1985;55:1403-1413.

11.

Willis

Ridge

JA.

Discordant lymphatic drainage patterns revealed by serial lymphoscintigraphy in cutaneous head and neck malignancies. Head Neck. 2007;29:979-985.

12.

Leong

Achtem

Habib

. Discordancy between clinical predictions vs lymphoscintigraphic and intraoperative mapping of sentinel lymph node drainage of primary melanoma. Arch Dermatol. 1999;135:1472-1476.

13.

Robbins

Shaha

Medina

. Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg. 2008;134:536-538.

14.

Reynolds

Smith

Uren

Thompson

Dunbar

PR.

Three-dimensional visualization of skin lymphatic drainage patterns of the head and neck. Head Neck. 2009;31:1316-1325.

15.

Tuomaala

Kivelä

Metastatic pattern and survival in disseminated conjunctival melanoma: implications for sentinel lymph node biopsy. Ophthalmology. 2004;111:816-821.

16.

Kyrgidis

Tzellos

Mocellin

. Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma. Cochrane Database Syst Rev. 2015;5(5):CD010307.

17.

Schmalbach

Bradford

CR.

Is sentinel lymph node biopsy the standard of care for cutaneous head and neck melanoma?

Laryngoscope. 2015;125:153-160.

18.

Eicher

Clayman

Myers

Gillenwater

AM.

A prospective study of intraoperative lymphatic mapping for head and neck cutaneous melanoma. Arch Otolaryngol Head Neck Surg. 2002;128:241-246.

19.

Maher

Hoffman

GR.

Head and neck cutaneous squamous cell carcinoma metastatic to cervical sublevel IIb lymph nodes occurred from primary sites involving the auricle and adjacent neck. J Oral Maxillofac Surg. 2014;72:627-632.

20.

Maher

Hoffman

GR.

Elective neck dissection for primary oral cavity squamous cell carcinoma involving the tongue should include sublevel IIb. J Oral Maxillofac Surg. 2014;72:2333-2343.

21.

Villaret

Piazza

Peretti

. Multicentric prospective study on the prevalence of sublevel IIb metastases in head and neck cancer. Arch Otolaryngol Head Neck Surg. 2007;133:897-903.