The use of lymphoscintigraphy and PET in the management of head and neck melanoma

OBJECTIVES: Lymphoscintigraphy with sentinel node dissection and 18 fluoro- 2-deoxyglucose positron emission tomography (PET) are being used independen tly in the management of many intermediate and thick melanomas of the head and neck. We report a series of patients with melanoma of the head and neck with Breslow depths greater than 1.0 mm and clinically negative regional n odes that were evaluated prospectively with PET and lymphoscintigraphy. STUDY DESIGN AND SETTING: Between July 1, 1998 and December 30, 2000 PET sc ans were obtained preoperatively on 18 patients undergoing resection of hea d and neck melanoma. Lymphoscintigraphy and sentinel node dissection was pe rformed. Resection of the primary lesion was then carried out with adequate margins and the defects were reconstructed. RESULTS: Sentinel node(s) were found in 17/18 patients (94.4%); 5/18 (27.8% ) of cases had metastases. PET detected nodal metastasis preoperatively in 3 patients (16.7%), one of which had a positive sentinel node dissection. CONCLUSION: PET and lymphoscintigraphy offer complimentary ways of evaluati on for metastatic melanoma.