Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long‐term Outcomes, Prognostic Value, Accuracy, and Safety

Hanks, John E.; Kovatch, Kevin J.; Ali, S. Ahmed; Roberts, Elizabeth S.; Durham, Alison B.; Smith, Joshua D.; Bradford, Carol R.; Malloy, Kelly M.; Boonstra, Philip S.; McLean, Scott A.

doi:10.1177/0194599819899934

Cited by 11 publications

(20 citation statements)

References 73 publications

(276 reference statements)

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“…However, our study shows that SLNB‐guided regional nodal management of cN0 HNCM is highly efficacious, evidenced by 85.4% regional disease control with 4.9 years of median follow‐up. Additionally, while parotid dissection was historically viewed as technically challenging and potentially dangerous, we demonstrate a low long‐term intraparotid false omission rate of 5.8%, which favorably compares to prior studies and is notably superior to the 6.4% long‐term false omission rate for the entire study cohort …”

Section: Discussionsupporting

confidence: 63%

“…Unlike the trunk and extremities, HNCM iCLND complications rarely include lymphedema due to watershed H&N lymphatic drainage . We have previously reported only a single case of mild lymphedema following iCLND in this cohort, resolving spontaneously within 4 weeks . Moreover, HNCM was historically viewed as sufficiently unique to evoke intense skepticism prior to SLNB's widespread adoption .…”

Section: Discussionmentioning

confidence: 78%

“…Thankfully, SLNB‐guided management's long‐term safety and fidelity at high‐volume centers make both regional recurrences and associated CN injuries rare events. We argue that iCLND should be favored over observation in HNCM to potentially prevent even rare recurrence‐related cranial neuropathies, given neck dissection's excellent safety profile . Conversely, no existing evidence supports clinical observation as sufficiently sensitive to prevent delayed CN injury as a presenting manifestation of recurrence.…”

Section: Discussionmentioning

confidence: 89%

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Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy

et al. 2019

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Objective Characterize long‐term cranial nerve (CN) outcomes following sentinel lymph node biopsy (SLNB) based management for head and neck cutaneous melanoma (HNCM). Methods Longitudinal review of HNCM patients undergoing SLNB from 1997–2007. Results Three hundred fifty‐six patients were identified, with mean age 53.5 ± 19.0 years, mean Breslow depth 2.52 ± 1.87 mm, and 4.9 years median follow‐up. One hundred five (29.4%) patients had SLNB mapping to the parotid basin. Eighteen patients had positive parotid SLNs and underwent immediate parotidectomy / immediate completion lymph node dissection (iCLND), with six possessing positive parotid non‐sentinel lymph nodes (NSLNs). Fifty‐two of 356 (14.6%) patients developed delayed regional recurrences, including 20 total intraparotid recurrences: five following false negative (FN) parotid SLNB, three following prior immediate superficial parotidectomy, two following iCLND without parotidectomy, and the remaining 12 parotid recurrences had negative extraparotid SLNBs. Parotid recurrences were multiple (4.9 mean recurrent nodes) and advanced (n = 4 extracapsular extension), and all required salvage dissection including parotidectomy. Immediate parotidectomy/iCLND led to no permanent CN injuries. Delayed regional HNCM macrometastasis precipitated 16 total permanent CN injuries in 13 patients: 10 CN VII, five CN XI, and one CN XII deficits. Fifty percent (n = 10) of parotid recurrences caused ≥1 permanent CN deficits. Conclusions Regional HNCM macrometastases and salvage dissection confer marked CN injury risk, whereas early surgical intervention via SLNB ± iCLND ± immediate parotidectomy yielded no CN injuries. Further, superficial parotidectomy performed in parotid‐mapping HNCM does not obviate delayed intraparotid recurrences, which increase risk of CN VII injury. Despite lack of a published disease‐specific survival advantage in melanoma, early disease control in cervical and parotid basins is paramount to minimize CN complications. Level of Evidence 4 (retrospective case series) Laryngoscope, 130:1707–1714, 2020

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 89%

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Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy

et al. 2019

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“…5 Unlike truncal and extremity melanomas, which are primarily managed by surgical oncologists, head and neck melanomas are often treated by surgeons of varying specialties such as plastic and reconstructive surgery, otorhinolaryngology, and oral and maxillofacial surgery. Furthermore, the utility of sentinel lymph node biopsy (SLNB) has been called into question due to concerns regarding feasibility and high rate of false negatives 3,6,7 ; consequently, widespread adoption of SLNB in H&N melanoma patients is more limited than for melanomas of other sites, and approaches for nodal sampling and dissection among surgeons within the United States vary widely. 8 Head and neck melanomas are also often near many critical anatomic structures, which are supplied by rich and variable vasculature and lymphatics.…”

Section: Introductionmentioning

confidence: 99%

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience

Baecher

Turgeon

Medin

et al. 2021

The American Surgeon™

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Background Outcomes are thought to be worse in head and neck (H&N) melanoma patients. However, definitive evidence of inferior outcomes in H&N melanoma in the modern era is lacking. We sought to ascertain whether H&N melanomas carry a worse prognosis than melanomas of other sites. Methods All patients who underwent excision for primary melanoma by fellowship-trained surgical oncologists at a single institution from 2014 to 2020 were queried from the electronic medical record. Patients who had AJCC eighth edition stage I-III disease were included. Results Of 1127 patients, 28.7% had primary H&N melanoma. H&N patients were more likely to be male, older, and present with more advanced AJCC stage. Median follow-up was 20.0 months (IQR 26.4). On multivariable analyses controlling for other variables, H&N melanoma was associated with worse RFS. Notably, H&N melanoma was not associated with worse MSS, DMFS, or OS on univariate or multivariable analyses. Among patients who recurred, H&N patients were significantly more likely to recur locally compared to non-H&N patients. On subgroup analysis, scalp melanoma was also associated with worse RFS compared to patients with melanoma in locations other than the scalp. When patients with scalp melanoma were excluded from analysis, non-scalp H&N RFS was not significantly different from the non-H&N group on univariate or multivariable analyses. Discussion In this series from a high-volume tertiary referral center, the differences in rates and sites of recurrence between H&N and non-H&N melanoma do not impact melanoma-specific or overall survival, suggesting that H&N melanoma patients should be treated similarly with respect to regional and systemic therapies.

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“…6,7 Meanwhile, lymphedema, a common morbidity from melanoma outside of the head and neck, is rarely identified in surgically treated survivors of HNCM. 5,8,9…”

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confidence: 99%

Impact of Completion Lymphadenectomy on Quality of Life for Head and Neck Cutaneous Melanoma

Farlow¹,

McLean²,

Peddireddy³

et al. 2021

Otolaryngol.--head neck surg.

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Objective Recent randomized data suggest that completion lymph node dissection after a positive sentinel lymph node biopsy (SLNB) improves locoregional control but does not improve survival for melanoma patients. Locoregional recurrences of head and neck cutaneous melanoma (HNCM) may result in significant morbidity. A better understanding of morbidity is thus important to inform decisions about whether to pursue completion neck dissection (ND). Study Design Cross-sectional study. Setting Academic tertiary care hospital. Methods Clinical data were collected for patients with HNCM seen between 2016 and 2019 who were at least 1-year disease free. Each patient completed the Self-administered Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS), Neck Dissection Impairment Index, and SF-36 (Short Form–36). Scores were compared by surgical treatment: wide local excision (WLE) only, SLNB, and ND. Univariate and multivariable regression was performed. Results Of 474 patients, 140 returned questionnaires (29.5% response rate; WLE, n = 49; SLNB, n = 76; ND, n = 15). No significant differences in SLANSS or Neck Dissection Impairment Index scores were found between the WLE and SLNB groups. SLANSS scores differed by 2 SD ( P = .001) in the ND cohort, which had a 36% rate of neuropathy. Neck impairment was worse by 1 SD ( P = .01) in the ND cohort. No differences were found in SF-36 domains. Conclusion Neuropathy and neck impairment are components of morbidity after ND. These risks must be balanced with potential morbidity of locoregional recurrence in HNCM.

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Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long‐term Outcomes, Prognostic Value, Accuracy, and Safety

Cited by 11 publications

References 73 publications

Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy

Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience

Impact of Completion Lymphadenectomy on Quality of Life for Head and Neck Cutaneous Melanoma

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