Cervical sentinel lymph node biopsy for melanomas of the head and neck andupper thorax

Objective: To describe a clinical experience with sentinel lymph node biops y (SLNB) of head and neck nodal basins for clinical stage I melanomas drain ing to these areas. Design: Consecutive clinical case series with a mean follow-up of 10.7 mont hs. Setting: University tertiary care referral medical center. Patients: Seventy patients with clinical stage I cutaneous melanoma who und erwent SLNB of cervical and/or parotid lymph node basins. Interventions: Patients underwent same-day preoperative technetium Tc 99m l ymphoscintigraphy followed by SLNB using gamma probe and blue dye (66 patie nts) and blue dye alone (4 patients). Patients with histological evidence o f tumor (hereinafter "positive") according to SLNB results underwenr modifi ed cervical completion lymph node dissection, including parotidectomy as ap propriate. Patients without histological evidence of tumor (hereinafter "ne gative") according to SLNB results were followed up clinically without unde rgoing completion lymph node dissection. Main Outcome Measures: The rates of SLNB success, SLNB positivity, completi on lymph node dissection positivity, complications, and SLNB false-negative results were determined by clinical follow-up. Results: Locations of melanomas in the 70 patients were the face (n= 20), n eck (n=14), ear (n = 9), scalp (n = 9), and upper thorax (n = 18). Location s of basins that underwent biopsy (n = 104) were in the cervical (n = 68), parotid (n = 19), and axillary (n = 17) regions. The mean Breslow thickness was 2.1 mm: (range, 0.4-12.0 mm). Sentinel lymph node biopsy-was successfu l in 103 basins (99%), The mean number of sentinel lymph nodes per basin wa s 2.5 (range, 1.0-8.0). Positive sentinel lymph nodes were found in 12 pati ents (17%) and 15 basins (14%). Sentinel lymph node biopsy results correlat ed with the American Joint Committee on Cancer tumor stage (P = .05) and a Breslow thickness of 1.23 mm or greater (P = .03). Additional tumor-contain ing nodes were noted in 5 (42%) of the 12 patients who underwent completion lymph node dissection, and these results correlated with the presence of m ultiple positive sentinel lymph nodes (P = .01). There were complications i n 3 patients (4%) (seromas in 2 patients and temporary spinal accessory ner ve paresis in 1 patient). One nodal recurrence in a basin that was negative according to SLNB results (SLNB with blue dye only) was noted (false-negat ive rate, 2%). The results of SLNB were accurate in 69 patients (99%). Conclusions: Sentinel lymph node biopsy using lymphoscintigraphy and blue d ye to manage cutaneous melanomas draining to the head and neck nodal areas is reliable. and safe. Sentinel lymph node biopsy results correlated with a Breslow thickness of 1.23 mm or greater and the American Joint Committee o n Cancer tumor stage. Completion lymph node dissection is recommended after determining positive SLNB results.