Accuracy and prognostic value of sentinel lymph node biopsy in head and neck melanomas

Background: Debate remains around the accuracy and prognostic implications of sentinellymph node biopsy (SLNB) for melanoma arising in the head and neck (HN) areas becauseseveral analyses have shown discordances between clinically predicted lymphaticdrainage pathways and those identified by lymphoscintigraphy. This study assesses theaccuracy and prognostic value of SLNB in this critical anatomic region.Methods: Retrospective review of a prospectively collected melanoma database identified331 patients with HN melanomas from January 2000 to December 2012. Primary end pointsincluded SLNB result, time to recurrence, site of recurrence, and survival. Multivariatemodels were constructed for analyses.Results: A sentinel lymph node (SLN) was identified in all 331 patients. There were 59 pa-tients with a positive SLN (17.8%) with a recurrence rate of 88.1% compared with 22.4% inSLN-negative patients (P < 0.0001). The 5-y overall survival was 91.2% for SLN-negativepatients and 48.7% for SLN-positive patients (P < 0.0001). Patients with scalp melanomahad thicker lesions and an elevated risk of SLN positivity, recurrence, and death comparedwith those with other sites. Among the 272 SLN-negative patients, four patients developedregional nodal disease in the same basin and had undergone a previous SLNB procedure fora false-omission rate of 1.45%. Risks for false-negative SLN occurrences included thick andscalp melanomas. Multivariate analysis on prognostic factors affecting relapse-free sur-vival showed positive SLNB status to be the most prognostic clinicopathologic predictor ofrecurrence (hazard ratio, 20.56; P < 0.0001).Conclusions: SLNB for patients with HN melanomas is an accurate procedure and hasprognostic value.a 2013 Elsevier Inc. All rights reserved.* Corresponding author. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan,Italy. Tel.: þ39 02 23902874; fax: þ39 02 23902404.E-mail address: andrea.maurichi@istitutotumori.mi.it (A. Maurichi).