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Sentinel lymph node biopsy for cutaneous head and neck melanomas
Snehal G Patel1, Daniel G Coit, Ashok R Shaha
1Head and Neck Service, PO Box 285, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Archives of Otolaryngology--Head & Neck Surgery
|March 12, 2002
Summary
Sentinel lymph node biopsy (SLNB) using combined technetium and blue dye improved identification rates for head and neck melanomas. SLNB accurately predicts nodal status but requires long-term follow-up for negative cases.
Area of Science:
- Oncology
- Surgical Pathology
- Dermatology
Background:
- Cutaneous head and neck melanomas (CMHNs) present unique challenges for staging.
- Sentinel lymph node biopsy (SLNB) is crucial for accurate nodal staging in melanoma patients.
Purpose of the Study:
- To evaluate the efficacy of SLNB in staging clinically node-negative CMHNs.
- To assess the impact of combined imaging and dye techniques on SLNB success rates.
Main Methods:
- A consecutive series of 56 patients with clinically node-negative CMHN underwent SLNB.
- Techniques included preoperative lymphoscintigraphy (PLSG) and intraoperative handheld gamma probe (IHGP) with isosulfan blue dye (IBD).
- Frozen section analysis guided immediate completion lymph node dissection.
Main Results:
- The combination of IHGP and IBD achieved a 96% SLN identification rate.
- SLNB correctly predicted regional nodal control in most patients, with a 2-year disease-specific survival of 93% for SLN-negative and 50% for SLN-positive cases.
- Four patients with positive SLNs on frozen section remained disease-free at 2 years.
Conclusions:
- Combining PLSG with IHGP and IBD enhances SLNB success rates for CMHN.
- SLNB is a reliable indicator of lymphatic basin status, but prolonged observation is necessary for patients with negative SLNs.
