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Predicting SLNB Positivity in Head and Neck Melanoma: A Nomogram and Online Risk Tool
Felipe Porto-Gutierrez1,2, Brett Campbell1,2, Valentina Montanez-Azcarate1,2
1Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA.
The Laryngoscope
|March 10, 2026
Summary
A new nomogram and calculator help estimate sentinel lymph node biopsy positivity for head and neck melanoma patients. This tool aids surgeons in personalized decision-making for early-stage cutaneous melanoma.
Area of Science:
- Oncology
- Surgical Oncology
- Dermatology
Background:
- Sentinel lymph node biopsy (SLNB) is standard for cutaneous melanoma staging.
- Current SLNB guidelines are not specific to head and neck melanomas.
- Existing risk models lack regional specificity.
Purpose of the Study:
- To develop and validate a nomogram and calculator for SLNB positivity in head and neck cutaneous melanoma.
- To improve risk stratification for this specific patient population.
Main Methods:
- Retrospective cohort study using the National Cancer Database (NCDB) from 2004-2021.
- Included 14,058 patients with clinical N0, M0 head and neck cutaneous melanoma undergoing SLNB.
- Multivariable logistic regression identified predictors of SLNB positivity.
Main Results:
- 15.5% of patients had a positive SLNB.
- Key predictors included age, sublocation, histology, mitotic rate, Breslow thickness, lymphovascular invasion, and ulceration.
- The developed nomogram showed good discrimination (C-index=0.724).
Conclusions:
- A validated predictive tool for SLNB positivity in head and neck melanoma is now available.
- This nomogram and calculator facilitate personalized surgical decision-making.
- Enhances risk assessment for early-stage head and neck cutaneous melanoma.
