Sentinel Lymph Node Biopsy Provides Prognostic Value in Thick Head and Neck Melanoma.

OBJECTIVES: Sentinel lymph node biopsy (SLNB) is standard practice for intermediate-thickness head and neck melanoma (HNM) but remains controversial for melanomas more than 4 mm in thickness. The objectives of this study were to evaluate (1) the diagnostic accuracy and (2) the prognostic value of SLNB in patients with thick HNM.

STUDY DESIGN: Case series with chart review.

SETTING: Large cancer center between June 2000 and December 2012.

SUBJECTS: 77 patients undergoing SLNB for T4 HNM without in-transit, regional, or distant metastatic disease at presentation.

METHODS: Univariate and multivariate analyses of prognostic factors were performed.

RESULTS: 77 patients underwent attempted SLNB for T4 HNM without in-transit, regional, or distant metastatic disease at presentation. The mean patient age was 62 years (range, 4-87 years) and there was a male predominance (80%). Mean Breslow thickness was 6.1 mm (range, 4-21 mm). Of the 77 patients undergoing attempted SLNB, 7 had no identifiable sentinel lymph node (9%). For the remaining 91% with 1 or more identifiable sentinel lymph nodes, the mean number of nodes identified was 3.3 (range, 1-13). The sentinel lymph node positivity rate was 24%. A false-negative SLNB occurred in 2 patients (3.8%). With a median follow-up of 36 months, the estimated 5-year disease-free, disease-specific, and overall survival rates were 47%, 74%, and 69%, respectively. A positive sentinel lymph node was significantly linked to shortened disease-free survival (74 vs 36 months, P = .026) and disease-specific survival (121 vs 59 months, P = .035).

CONCLUSION: SLNB provides accurate staging of the regional node basin and important prognostic information for patients with thick HNM.