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Sentinel node biopsy for head and neck desmoplastic melanoma: not a given
Robert W Eppsteiner1, Brian L Swick, Mohammed M Milhem
1Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Objectives:
Determine the frequency of, the characteristics predictive of, and potential associated survival benefit from sentinel lymph node biopsy in a population of patients with desmoplastic melanoma of the head and neck.
Study Design:
Analysis of a national database.
Setting:
The 17-registry Surveillance, Epidemiology, and End Results (SEER) database.
Subjects And Methods:
Using the SEER database, the authors identified patients diagnosed with cutaneous desmoplastic melanoma of the head and neck between 2003 and 2007. Nodal metastasis and impact of sentinel lymph node biopsy on survival were determined.
Results:
The authors identified 467 cases of desmoplastic melanoma. Although most were locally advanced (median Breslow depth 3.5 mm), few had regional lymph node metastases (3.4%) or distant spread (3.2%) at the time of initial management. Of 165 patients who had sentinel lymph node biopsy, 5% had positive regional lymph nodes. Breslow depth, ulceration, age, and sex were not predictive of positive sentinel lymph node biopsy. Patients who had sentinel lymph node biopsy did not have different cause-specific survival from those who did not undergo sentinel lymph node biopsy.
Conclusion:
Positive sentinel lymph node biopsies are rare in patients with desmoplastic melanoma of the head and neck. The low (5%) incidence of positive sentinel lymph node biopsy, coupled with the absence of identifiable survival benefit from its use, supports a more selective application of sentinel lymph node biopsy to this group of patients.
