Predicting SLNB Positivity in Head and Neck Melanoma: A Nomogram and Online Risk Tool

Sentinel lymph node biopsy (SLNB) is the standard staging procedure in cutaneous melanoma of the head and neck, but current guidelines are extrapolated from non-head and neck studies. Existing risk models lack specificity for this region. Using the National Cancer Database, we developed and internally validated a nomogram and web-based calculator to estimate SLNB positivity specifically in head and neck cutaneous melanoma.

We conducted a retrospective cohort study using the NCDB, including patients with cutaneous melanoma of the head and neck. The inclusion criteria were patients with clinical node-negative, early-stage melanoma who underwent SLNB between 2004 and 2021. Demographic, clinical, and pathologic features were compared using chi-squared testing, and multivariable logistic regression identified independent predictors of SLNB positivity. Significant factors were incorporated into a nomogram and interactive risk calculator.

We included 14,058 clinical N0, M0 cutaneous head and neck melanoma patients who underwent SLNB. Of these, 2182 (15.5%) had a positive SLNB. In multivariable analysis, age, head and neck sublocation, histologic subtype, mitotic rate, Breslow thickness, lymphovascular invasion, and ulceration were identified as independent predictors of SLNB positivity. A nomogram based on these variables was developed. The model demonstrated good discrimination with a C-index of 0.724 (95% CI, 0.712-0.735).

This study provides a predictive tool that allows head and neck surgeons to estimate the risk of SLNB positivity in individual patients, enabling more personalized surgical decision-making in early-stage head and neck melanoma.