Recurrence of cutaneous melanoma of the head and neck after negative sentinel lymph node biopsy

Abstract

For CMHN, regional recurrence after negative sentinel lymph node biopsy occurs at acceptably low rates relative to other sites, although it is associated with adverse survival.

Patterns of recurrence and retreatment outcomes among clinical stage I and II head and neck melanoma patients

“…The MSLT did find that patients who underwent SLNB had significantly improved disease‐free survival (71%) when compared to patients who underwent observation of regional lymphatics (64%) . Prior studies have found that regional recurrence occurs in approximately 8% of patients who are found to have a negative SLNB, which correlates well with the 4% in our study . It has been shown that nodal drainage basins in the head and neck are variable among individuals and it has also been shown that all patients with CMHN anterior to the external auditory canal are at risk for intraparotid lymph node metastases .…”

“…11 Prior studies have found that regional recurrence occurs in approximately 8% of patients who are found to have a negative SLNB, which correlates well with the 4% in our study. 13 It has been shown that nodal drainage basins in the head and neck are variable among individuals and it has also been shown that all patients with CMHN anterior to the external auditory canal are at risk for intraparotid lymph node metastases. 9,14,15 Twenty-seven percent (3/11) of the positive sentinel lymph node biopsies in this study were intraparotid lymph nodes (Table 3).…”

Does the number of sentinel lymph nodes removed affect the false negative rate for head and neck melanoma?

“…In addition, the proximity of the primary site to draining lymph node basins may preclude accurate tracer identification of the SLN. Although sentinel lymph node biopsy (SLNB) for HN melanoma is generally considered accurate and prognostic, some studies suggest SLNB in HN melanoma may not be as accurate compared to SLNB in extremity and truncal melanoma . In a report of 2079 cutaneous melanoma patients undergoing SLNB, HN had the lowest SLN‐positive rate (10.8%) compared to extremity (16.5%), or truncal (19.3%), but HN melanoma had a worse 5‐year disease free survival …”

“…Although sentinel lymph node biopsy (SLNB) for HN melanoma is generally considered accurate and prognostic, some studies suggest SLNB in HN melanoma may not be as accurate compared to SLNB in extremity and truncal melanoma. 3,4 In a report of 2079 cutaneous melanoma patients undergoing SLNB, HN had the lowest SLN-positive rate (10.8%) compared to extremity (16.5%), or truncal (19.3%), but HN melanoma had a worse 5-year disease free survival. 5 In addition to lower rates of SLNB positivity, SLNB for HN melanoma is also associated with higher rates of false negative SLNBs;…”

Aberrant lymphatic drainage and risk for melanoma recurrence after negative sentinel node biopsy in middle‐aged and older men

“…The clinical significance of unexpected drainage remains unclear, because few studies have compared lymphatic anatomy to cancer biology and outcomes before and after intervention . However, correlations between ambiguous, multiple lymphatic basin drainage from scalp primaries and regional recurrence after negative SLNB have been observed …”