Sentinel node biopsy in patients with cutaneous melanoma of the head and neck

Biopsy of head and neck sentinel nodes (SNs) can be technically problematic due to the unpredictable and variable drainage patterns of this anatomic r egion. The aim of the present study was to evaluate the feasibility of SN b iopsy for cutaneous melanoma of the head and neck. We performed SN biopsy i n 17 patients affected by stage I cutaneous melanoma of the head and neck o n the basis of lymphoscintigraphy, blue dye and gamma probe. A total of 24 procedures were performed. Drainage to more than one lymphatic basin was ob served in five patients (two basins in three cases and three basins in two cases) and in all cases SN biopsy was performed In all basins. The biopsy d istribution by site was: six cervical nodes, five parotid nodes, four supra clavicular and submandibular nodes, three auricular and axillary nodes. The SN identification rate was 87.5% (21/24); metastases were discovered in fo ur cases, with a positivity rate of 23.6%, At the time of writing, 1 patien t is alive with local disease, 3 patients are dead and 13 are alive and fre e of disease with a follow-up ranging from 1 to 40 months (median, 21 month s) following SN biopsy. In our opinion preoperative lymphoscintigraphy and the intraoperative use of a gamma probe are useful for the identification o f lymphatic drainage of cutaneous melanoma of the head and neck.