Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long-term Outcomes, Prognostic Value, Accuracy, and Safety

• Published in: Otolaryngology-head and neck surgery Vol. 162; no. 4; p. 520
• Main Authors: Hanks, John E, Kovatch, Kevin J, Ali, S Ahmed, Roberts, Emily, Durham, Alison B, Smith, Joshua D, Bradford, Carol R, Malloy, Kelly M, Boonstra, Philip S, Lao, Christopher D, McLean, Scott A
• Format: Journal Article
• Language: English
• Published: England 01.04.2020
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cohort Studies; Female; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Humans; Male; Melanoma - mortality; Melanoma - pathology; Middle Aged; Prognosis; Reproducibility of Results; Retrospective Studies; Sentinel Lymph Node Biopsy - adverse effects; Skin Neoplasms - mortality; Skin Neoplasms - pathology; Survival Rate; Time Factors; Treatment Outcome; Young Adult; cutaneous; false omission; head and neck; melanoma; sentinel lymph node biopsy; otolaryngology
• ISSN: 1097-6817
• DOI: 10.1177/0194599819899934

To evaluate the long-term outcomes of sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma (HNCM). Retrospective cohort study. Tertiary academic medical center. Longitudinal review of a 356-patient cohort with HNCM undergoing SLNB from 1997 to 2007. Descriptive characteristics included the following: age, 53.5 ± 19 years (mean ± SD); sex, 26.8% female; median follow-up, 4.9 years; and Breslow depth, 2.52 ± 1.87 mm. Overall, 75 (21.1%) patients had a positive SLNB. Among patients undergoing completion lymph node dissection following positive SLNB, 20 (27.4%) had at least 1 additional positive nonsentinel lymph node. Eighteen patients with local control and negative SLNB developed regional disease, indicating a false omission rate of 6.4%, including 10 recurrences in previously unsampled basins. Ten-year overall survival (OS) and melanoma-specific survival (MSS) were significantly greater in the negative sentinel lymph node (SLN) cohort (OS, 61% [95% CI, 0.549-0.677]; MSS, 81.9% [95% CI, 0.769-0.873]) than the positive SLN cohort (OS, 31% [95% CI, 0.162-0.677]; MSS, 60.3% [95% CI, 0.464-0.785]) and positive SLN/positive nonsentinel lymph node cohort (OS, 8.4% [95% CI, 0.015-0.474]; MSS, 9.6% [95% CI, 0.017-0.536]). OS was significantly associated with SLN positivity (hazard ratio [HR], 2.39; < .01), immunosuppression (HR, 2.37; < .01), angiolymphatic invasion (HR, 1.91; < .01), and ulceration (HR, 1.86; < .01). SLN positivity (HR, 3.13; < .01), angiolymphatic invasion (HR, 3.19; < .01), and number of mitoses ( = .0002) were significantly associated with MSS. Immunosuppression (HR, 3.01; < .01) and SLN status (HR, 2.84; < .01) were associated with recurrence-free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR, 6.59; < .01). Long-term follow up indicates that SLNB showcases durable accuracy, safety, and prognostic importance for cutaneous HNCM.