Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma

Abstract

BACKGROUND: Sentinel lymph node biopsy (SLNB) has emerged as a widely used staging procedure for cutaneous melanoma. However, debate remains around the accuracy and prognostic implications of SLNB for cutaneous melanoma arising in the head and neck, as previous reports have demonstrated inferior results to those in nonhead and neck regions. Through the largest single‐institution series of head and neck melanoma patients, the authors set out to demonstrate that SLNB accuracy and prognostic value in the head and neck region are comparable to other sites. METHODS: A prospectively collected database was queried for cutaneous head and neck melanoma patients who underwent SLNB at the University of Michigan between 1997 and 2007. Primary endpoints included SLNB result, time to recurrence, site of recurrence, and date and cause of death. Multivariate models were constructed for analyses. RESULTS: Three hundred fifty‐three patients were identified. A sentinel lymph node was identified in 352 of 353 patients (99.7%). Sixty‐nine of the 353 (19.6%) patients had a positive SLNB. Seventeen of 68 patients (25%) undergoing completion lymphadenectomy after a positive SLNB result had at least 1 additional positive nonsentinel lymph node. Patients with local control and a negative SLNB failed regionally in 4.2% of cases. Multivariate analysis revealed positive SLNB status to be the most prognostic clinicopathologic predictor of poor outcome; hazard ratio was 4.23 for SLNB status and recurrence‐free survival ( P < .0001) and 3.33 for overall survival ( P < .0001). CONCLUSIONS: SLNB is accurate and its results are of prognostic importance for head and neck melanoma patients. Cancer 2012;. © 2011 American Cancer Society. This is the largest single‐institution series of patients with head and neck melanoma (n = 353) to date. The authors demonstrate sentinel lymph node biopsy to be reliable (99.7% identification rate), accurate (19.7% positive sentinel lymph node biopsy rate and 4.2% false‐omission rate), and strongly prognostic of survival on multivariate analysis.