Sentinel lymph node biopsy in cutaneous head and neck melanoma

Evrard, Diane; Routier, Émilie; Mateus, Christine; Tomasic, Gorana; Lombroso, J.; Kolb, F.; Robert, Caroline; Moya‐Plana, Antoine

doi:10.1007/s00405-018-4934-3

Cited by 15 publications

(20 citation statements)

References 26 publications

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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%

“…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 . Likewise, our study suggests that MSLT‐II's conclusions similarly warrant intense scrutiny before abandoning H&N iCLND, which may increase CN injury frequency and severity .…”

Section: Discussionmentioning

confidence: 72%

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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: 72%

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

et al. 2019

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“…9,26-29 Since then, studies at other institutions have replicated and confirmed these findings. 9,30-32 We present an updated analysis of Erman and colleagues’ large single-institution HNCM cohort 9 with long-term follow-up, which validates SLNB’s long-term safety, accuracy, and prognostic utility for HNCM. SLN status remains highly prognostic for OS, MSS, RFS, and regional RFS.…”

Section: Discussionmentioning

confidence: 62%

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

Hanks

Kovatch

Ali

et al. 2020

Otolaryngol.--head neck surg.

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Objective To evaluate the long-term outcomes of sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma (HNCM). Study Design Retrospective cohort study. Setting Tertiary academic medical center. Subjects and Methods Longitudinal review of a 356-patient cohort with HNCM undergoing SLNB from 1997 to 2007. Results Descriptive characteristics included the following: age, 53.5 ± 19 years (mean ± SD); sex, 26.8% female; median follow-up, 4.9 years; and Breslow depth, 2.52 ± 1.87 mm. Overall, 75 (21.1%) patients had a positive SLNB. Among patients undergoing completion lymph node dissection following positive SLNB, 20 (27.4%) had at least 1 additional positive nonsentinel lymph node. Eighteen patients with local control and negative SLNB developed regional disease, indicating a false omission rate of 6.4%, including 10 recurrences in previously unsampled basins. Ten-year overall survival (OS) and melanoma-specific survival (MSS) were significantly greater in the negative sentinel lymph node (SLN) cohort (OS, 61% [95% CI, 0.549-0.677]; MSS, 81.9% [95% CI, 0.769-0.873]) than the positive SLN cohort (OS, 31% [95% CI, 0.162-0.677]; MSS, 60.3% [95% CI, 0.464-0.785]) and positive SLN/positive nonsentinel lymph node cohort (OS, 8.4% [95% CI, 0.015-0.474]; MSS, 9.6% [95% CI, 0.017-0.536]). OS was significantly associated with SLN positivity (hazard ratio [HR], 2.39; P < .01), immunosuppression (HR, 2.37; P < .01), angiolymphatic invasion (HR, 1.91; P < .01), and ulceration (HR, 1.86; P < .01). SLN positivity (HR, 3.13; P < .01), angiolymphatic invasion (HR, 3.19; P < .01), and number of mitoses ( P = .0002) were significantly associated with MSS. Immunosuppression (HR, 3.01; P < .01) and SLN status (HR, 2.84; P < .01) were associated with recurrence-free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR, 6.59; P < .01). Conclusions Long-term follow up indicates that SLNB showcases durable accuracy, safety, and prognostic importance for cutaneous HNCM.

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“…18 These factors included tumor thickness <2 mm and absence of ulceration. 17,19 Therefore, we performed a subgroup analysis in patients under the age of 60, with non-ulcerated tumors, and Breslow thickness <2 mm. No statistically significant OS difference was found between the SLNB only and the SLNB + CLND groups in this subanalysis, as shown in Figure 3 (87.4% vs 80.3%; P = .47).…”

Section: Subgroup Analysesmentioning

confidence: 99%

“…[10][11][12][13] Dedicated CHNM studies have demonstrated that SLNB is a safe and reliable technique, [14][15][16] and that SLNB status is a strong prognostic factor. 17 The therapeutic role of SLNB and the survival benefit of CLND, however, is less defined in CHNM.…”

Section: Introductionmentioning

confidence: 99%

Completion lymph node dissection in patients with sentinel lymph node positive cutaneous head and neck melanoma

Huang¹,

Misra²,

Lemini

et al. 2020

Journal of Surgical Oncology

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Background: Relatively few cutaneous head and neck melanoma (CHNM) patients with were included in the multicenter selective lymphadenectomy trial II (MSLT-II). Our objective was to investigate whether immediate completion lymph node dissection completion of lymph node dissection (CLND) was associated with survival benefit for sentinel lymph node (SLN) positive CHNM using the National Cancer Database. Methods: SLN positive patients with CHNM from 2012 to 2014 were retrospectively analyzed. Patients were divided into two groups: those who underwent SLN biopsy (SLNB) only versus those who underwent SLNB followed by CLND (SLNB + CLND). The primary outcome was 5-year overall survival (OS). Results: Among 530 SLNB + patients, 342 patients underwent SLNB followed by CLND (SLNB + CLND). The SLNB only group had fewer positive SLN, less advanced pathologic stage, and a lower rate of adjuvant immunotherapy. There was no significant difference in 5-year OS between the two groups (51.0% vs 67%; P = .56). After adjusting for pathologic stage, there remained no difference in 5-year OS among patients with stage IIIA (63.0% vs. 73.6%, P = 0.22) or IIIB/IIIC disease (39.1% vs 57.8%; P = .52). Conclusions Using a large nationwide database, CLND was not shown to be associated with improved OS for patients with SLNB positive CHNM, validating the results of MSLT-II.

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Sentinel lymph node biopsy in cutaneous head and neck melanoma

Abstract: As in other sites, SLNB status is a strong prognostic factor with comparable false omission rate and no superior morbidity.

Cited by 15 publications

References 26 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

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

Completion lymph node dissection in patients with sentinel lymph node positive cutaneous head and neck melanoma

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