title: Do nodal metastases from cutaneous melanoma of the head and neck follow a clinically predictable pattern?
abstract: BACKGROUND
  Potential lymphatic drainage patterns from cutaneous melanomas of the head and neck are said to be variable and frequently unpredictable. The aim of this article is to correlate the anatomic distribution of pathologically involved lymph nodes with primary melanoma sites and to compare these findings with clinically predicted patterns of metastatic spread.
  
  
  METHODS
  A prospectively documented series of 169 patients with pathologically proven metastatic melanoma was reviewed by analyzing the clinical, operative, and pathologic records. Clinically, it was predicted that melanomas of the anterior scalp, forehead, and face could metastasize to the parotid and neck levels I-III; the coronal scalp, ear, and neck to the parotid and levels I-V; the posterior scalp to occipital nodes and levels II-V; and the lower neck to levels III-V. Minimum follow up was 2 years.
  
  
  RESULTS
  There were 141 therapeutic (97 comprehensive, 44 selective) and 28 elective lymphadenectomies (4 comprehensive dissections, 21 selective neck dissections, and 3 cases in which parotidectomy alone was performed). Overall, there were 112 parotidectomies, 44 of which were therapeutic and 68 elective. Pathologically positive nodes involved clinically predicted nodal groups in 156 of 169 cases (92.3%). The incidence of postauricular node involvement was only 1.5% (3 cases). No patient was initially seen with contralateral metastatic disease; however, 5 patients (2.9%) failed in the contralateral neck after therapeutic dissection. In 68% of patients, metastatic disease involved the nearest nodal group, and in 59% only a single node was involved.
  
  
  CONCLUSIONS
  Cutaneous malignant melanomas of the head and neck metastasized to clinically predicted nodal groups in 92% of patients in this series. Postauricular and contralateral metastatic node involvement was uncommon.
authors.affiliation: Department of Head and Neck Surgery, Suite 209, RPAH Medical Centre, 100 Carillon Ave, Newtown 2042, NSW, Australia. head&neck@rpamail.cs.nsw.gov.au
authors.forename: I
authors.initials: I
authors.lastname: Pathak
authors.forename: C J
authors.initials: CJ
authors.lastname: O'Brien
authors.forename: K
authors.initials: K
authors.lastname: Petersen-Schaeffer
authors.forename: E B
authors.initials: EB
authors.lastname: McNeil
authors.forename: J
authors.initials: J
authors.lastname: McMahon
authors.forename: M J
authors.initials: MJ
authors.lastname: Quinn
authors.forename: J F
authors.initials: JF
authors.lastname: Thompson
authors.forename: W H
authors.initials: WH
authors.lastname: McCarthy
mesh_terms: D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D011877:Radionuclide Imaging; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*