Sentinel Node Biopsy for Head and Neck Melanoma

Abstract

Objective. This systematic review was conducted to examine the test performance of sentinel node biopsy in head and neck melanoma, including the identification rate and false-negative rate.Data Sources. PubMed, EMBASE, ASCO, and SSO database searches were conducted to identify studies fulfilling the following inclusion criteria: sentinel node biopsy was performed, lesions were located on the head and neck, and recurrence data for both metastatic and nonmetastatic patients were reported.Review Methods. Dual-blind data extraction was conducted. Primary outcomes included identification rate and test performance based on completion neck dissection or nodal recurrence.Results. A total of 3442 patients from 32 studies published between 1990 and 2009 were reviewed. Seventy-eight percent of studies were retrospective and 22% were prospective. Trials varied from 9 to 755 patients (median 55). Mean Breslow depth was 2.53 mm. Median sentinel node biopsy identification rate was 95.2%. More than 1 basin was reported in 33.1% of patients. A median of 2.56 sentinel nodes per patient were excised. Sentinel node biopsy was positive in 15% of patients. Subsequent completion neck dissection was performed in almost all of these patients and revealed additional positive nodes in 13.67%. Median follow-up was 31 months. Across all studies, predictive value positive for nodal recurrence was 13.1% and posttest probability negative was 5%. Median false-negative rate for nodal recurrence was 20.4%. Conclusion.Sentinel node biopsy of head and neck melanoma is associated with an increased false-negative rate compared with studies of non-head and neck lesions. Positive sentinel node status is highly predictive of recurrence.Keywords head and neck melanoma, sentinel lymph node biopsy, falsenegative rate, systematic review Received September 30, 2010; revised March 29, 2011; accepted April 6, 2011. A n estimated 68,130 new cases of malignant melanoma were predicted to be diagnosed in 2010, resulting in 8700 deaths.1 Approximately 20% of primary lesions are located on the head and neck. Mortality rates among head and neck melanomas differ by site; lesions of the scalp and neck have the highest mortality, with a 10-year survival of 60%. Tumors located on the ear, face, and eyelid have 10-year survival rates of 70%, 80%, and 90%, respectively. 2Occult lymph node metastasis is present in 15% to 20% of patients with melanoma of the head and neck and clinically negative nodes.3,4 Elective lymph node dissection (ELND) has been used to stage melanoma of the head and neck in these patients; however, morbidity associated with ELND includes cranial nerve XI transection, marginal nerve injury, and chyle leak.5-8 Furthermore, no clear survival benefit has been shown with ELND. 9 The Intergroup Melanoma Trial, a randomized controlled trial by Balch et al, 9 included patients with head and neck melanoma in combination with truncal melanomas and analyzed the survival difference between ELND and a "watch and wait" algorithm. This study showed no su...

EANM practice guidelines for lymphoscintigraphy and sentinel lymph node biopsy in melanoma

“…In the head and neck area, the procedure is more challenging because of the intricacy of lymphatic drainage patterns, the complexity of the local anatomy and the shine-through phenomenon [41,42]. However, an SLN detection rate of 95.2 % has been reported [43], which can be improved by additional dynamic lymphoscintigraphy [44] preoperative SPECT/CT and the intraoperative use of the gamma probe [45].…”

FoxP3 and indoleamine 2,3-dioxygenase immunoreactivity in sentinel nodes from melanoma patients

“…It can be identified by dye, gamma probe, lymphoscintigraphy or a combination at a rate of 94% [11]. SLNs may contain macrometastases, which are evident on exam or imaging, or sub-clinical micrometasteses.…”

Acute Toxoplasmosis Mimicking Melanoma Metastases: Review of Conditions Causing False-Positive Results on ¹⁸F-FDG PET/CT

“…Mortality rates among head and neck melanomas differ by site: lesions of the scalp and neck have the highest mortality, with a 10-year survival of 60%. Tumors located on the ear, face, and eyelid have 10-year survival rates of 70, 80 and 90%, respectively [22,23]. Advanced age, male sex, nodular morphological features, tumor thickness, ulceration, and Clark level V carry a significant risk of death for cutaneous head and neck melanoma, whereas facial melanomas have a favorable prognosis [23].…”

“…However, the combination of preoperative US and US-guided FNA cytology can identify 65% of SN metastases and thus reduce the need for surgical SN procedures [25]. De Rosa et al [22] reported a highly successful identification (93.4%) of the SN in head and neck melanoma. However, despite the technical success, this procedure results in an elevated false-negative rate (20.4%) compared with non-head and neck lesions.…”