Sentinel lymph node biopsy in head and neck melanoma*

The purpose of this study is to evaluate prognosis and surgical management of head and neck melanoma (HNM) and the accuracy of sentinel lymph node biopsy (SLNB).

All patients with a primary cutaneous melanoma treated starting from 01/07/1994 to 31/12/2012 in the department of Plastic and Reconstructive Surgery of Bari are included in a electronic clinical medical registry. Within the 90th day from excision of the primary lesion all patients with adverse prognostic features underwent SLNB. All patients with positive findings underwent lymphadenectomy.

out of 680 patients affected by melanoma, 84 (12.35%) had HNM. In the HNM cohort lymphoscintigraphy was performed in 57 patients, 15 of which (26.3%) were positive. The percentage of unfound sentinel lymph node was similar both to the HNM group (5,26%) and to patients with melanoma of different sites (OMS 4,92%). There was a recurrence of disease after negative SLNB (false negatives) only in 4 cases. Recurrence-free period and survival rate at 5 years were worse in HNM cohort.

SLNB of HNM has been for a long time contested due to its complex lymphatic anatomy, but recent studies agreed with this technique. Our experience showed that identification of sentinel lymph node in HNM cohort was possible in 98.25% of cases. Frequency of interval nodes is significantly higher in HNM group. The prognosis of HNM cohort is significantly shorter than OMS one. Finally, this procedure requires a multidisciplinary team in referral centers.