Parotid selective lymphadenectomy in malignant melanoma

Malignant melanoma of the head and neck can metastasize to lymph nodes with in the parotid gland. Selective lymphadenectomy is the modern method of sta ging regional lymph node basins in clinically localized melanoma. This proc edure involves intraoperative lymphatic mapping and directed, selective rem oval of the first draining nodes or sentinel lymph nodes (SLNs), Historical ly, the assessment of parotid lymph nodes would involve a superficial parot idectomy with facial nerve dissection. Since 1993, 28 patients with localiz ed melanoma of the head and neck have demonstrated lymphatic drainage to pa rotid lymph nodes on preoperative lymphoscintigraphy. The overall success r ate of parotid selective lymphadenectomy is 86% (24 of 28 patients). Of the 28 patients, there were 6 early patients in whom blue dye alone was utiliz ed intraoperatively, and the success rate is 50% (3 of 6 patients). When bl ue dye and radiocolloid mapping techniques are combined, the parotid select ive lymphadenectomy is successful in 95% of patients (21 of 22 patients), F our of the 24 patients (17%) had metastases to the SLNs and underwent thera peutic superficial parotidectomy and/or modified radical neck dissection. A fter completion of the therapeutic superficial parotidectomy, 1 of the 4 pa tients was found to have an additional parotid (nonsentinel) node with mela noma metastases. None of the patients incurred injury to the facial nerve b y parotid selective lymphadenectomy. To date, 2 of 28 patients (7%) have ha d regional recurrence to the parotid gland. Failure of the SLN technique ma y occur when blue dye alone is used, when human serum albumin (not sulfur c olloid) is the radiocolloid, when prior wide excision and skin graft is pre sent before lymphatic mapping, and when all SLNs are not retrieved. We conc lude that parotid selective lymphadenectomy is a safe and reliable alternat ive to superficial parotidectomy for staging clinically localized melanoma of the head and neck.