Do nodal metastases from cutaneous melanoma of the head and neck follow a clinically predictable pattern?

Background. Potential lymphatic drainage patterns from cutaneous melanomas of the head and neck are said to be variable and frequently unpredictable. The aim of this article is to correlate the anatomic distribution of pathol ogically involved lymph nodes with primary melanoma sites and to compare th ese findings with clinically predicted patterns of metastatic spread. Methods. A prospectively documented series of 169 patients with pathologica lly proven metastatic melanoma was reviewed by analyzing the clinical, oper ative, and pathologic records. Clinically, it was predicted that melanomas of the anterior scalp, forehead, and face could metastasize to the parotid and neck levels I-III; the coronal scalp, ear, and neck to the parotid and levels I-V; the posterior scalp to occipital nodes and levels II-V; and the lower neck to levels III-V. Minimum follow up was 2 years. Results. There were 141 therapeutic (97 comprehensive, 44 selective) and 28 elective lymphadenectomies (4 comprehensive dissections, 21 selective neck dissections, and 3 cases in which parotidectomy alone was performed). Over all, there were 112 parotidectomies, 44 of which were therapeutic and 68 el ective. Pathologically positive nodes involved clinically predicted nodal g roups in 156 of 169 cases (92.3%). The incidence of postauricular node invo lvement was only 1.5% (3 cases). No patient was initially seen with contral ateral metastatic disease; however, 5 patients (2.9%) failed in the contral ateral neck after therapeutic dissection. In 68% of patients, metastatic di sease involved the nearest nodal group, and in 59% only a single node was i nvolved. Conclusions. Cutaneous malignant melanomas of the head and neck metastasize d to clinically predicted nodal groups in 92% of patients in this series. P ostauricular and contralateral metastatic node involvement was uncommon. (C ) 2001 John Wiley & Sons, Inc.