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. 2020 Apr;162(4):520-529.
doi: 10.1177/0194599819899934. Epub 2020 Feb 11.

Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long-term Outcomes, Prognostic Value, Accuracy, and Safety

John E Hanks  1 , Kevin J Kovatch  1 , S Ahmed Ali  1 , Emily Roberts  2 , Alison B Durham  3 , Joshua D Smith  1 , Carol R Bradford  1   4 , Kelly M Malloy  1 , Philip S Boonstra  2 , Christopher D Lao  5 , Scott A McLean  1
Affiliations

Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long-term Outcomes, Prognostic Value, Accuracy, and Safety

John E Hanks et al. Otolaryngol Head Neck Surg. 2020 Apr.

Abstract

Objective: To evaluate the long-term outcomes of sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma (HNCM).

Study design: Retrospective cohort study.

Setting: Tertiary academic medical center.

Subjects and methods: Longitudinal review of a 356-patient cohort with HNCM undergoing SLNB from 1997 to 2007.

Results: Descriptive characteristics included the following: age, 53.5 ± 19 years (mean ± SD); sex, 26.8% female; median follow-up, 4.9 years; and Breslow depth, 2.52 ± 1.87 mm. Overall, 75 (21.1%) patients had a positive SLNB. Among patients undergoing completion lymph node dissection following positive SLNB, 20 (27.4%) had at least 1 additional positive nonsentinel lymph node. Eighteen patients with local control and negative SLNB developed regional disease, indicating a false omission rate of 6.4%, including 10 recurrences in previously unsampled basins. Ten-year overall survival (OS) and melanoma-specific survival (MSS) were significantly greater in the negative sentinel lymph node (SLN) cohort (OS, 61% [95% CI, 0.549-0.677]; MSS, 81.9% [95% CI, 0.769-0.873]) than the positive SLN cohort (OS, 31% [95% CI, 0.162-0.677]; MSS, 60.3% [95% CI, 0.464-0.785]) and positive SLN/positive nonsentinel lymph node cohort (OS, 8.4% [95% CI, 0.015-0.474]; MSS, 9.6% [95% CI, 0.017-0.536]). OS was significantly associated with SLN positivity (hazard ratio [HR], 2.39; P < .01), immunosuppression (HR, 2.37; P < .01), angiolymphatic invasion (HR, 1.91; P < .01), and ulceration (HR, 1.86; P < .01). SLN positivity (HR, 3.13; P < .01), angiolymphatic invasion (HR, 3.19; P < .01), and number of mitoses (P = .0002) were significantly associated with MSS. Immunosuppression (HR, 3.01; P < .01) and SLN status (HR, 2.84; P < .01) were associated with recurrence-free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR, 6.59; P < .01).

Conclusions: Long-term follow up indicates that SLNB showcases durable accuracy, safety, and prognostic importance for cutaneous HNCM.

Keywords: cutaneous; false omission; head and neck; melanoma; otolaryngology; sentinel lymph node biopsy.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest related to this work.

Figures

Figure 1a.
Figure 1a.
Survival and recurrence Kaplan-Meier curves by SLN status. X-axis: time (years), Y-Axis: Survival Probability. A) OS, B) MSS, C) Progression free survival. “-SLNB”=negative SLNB; “+SLNB”= positive SLNBs; “+SLNB/-NSLN”=positive SLNB/negative NSLN; “+SLNB/+NSLN”= positive SLNB/positive NSLN(s)
Figure 1a.
Figure 1a.
Survival and recurrence Kaplan-Meier curves by SLN status. X-axis: time (years), Y-Axis: Survival Probability. A) OS, B) MSS, C) Progression free survival. “-SLNB”=negative SLNB; “+SLNB”= positive SLNBs; “+SLNB/-NSLN”=positive SLNB/negative NSLN; “+SLNB/+NSLN”= positive SLNB/positive NSLN(s)
Figure 1a.
Figure 1a.
Survival and recurrence Kaplan-Meier curves by SLN status. X-axis: time (years), Y-Axis: Survival Probability. A) OS, B) MSS, C) Progression free survival. “-SLNB”=negative SLNB; “+SLNB”= positive SLNBs; “+SLNB/-NSLN”=positive SLNB/negative NSLN; “+SLNB/+NSLN”= positive SLNB/positive NSLN(s)
Figure 2:
Figure 2:
Kaplan-Meier curve for OS among patients with positive SLN having undergone iCLND, stratified by the number of positive NSLNs. X-axis: time (years), Y-Axis: Survival Probability. “O” = NSLNs negative, “>0”= 1 or more positive NSLN(s)
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