Sentinel lymph node biopsy for cutaneous head and neck melanomas.
OBJECTIVE
To report the results of sentinel lymph node biopsy (SLNB) for cutaneous head and neck melanomas (CMHNs).


METHODS
Consecutive series followed for a median of 20 months.


METHODS
Tertiary cancer care center.


METHODS
Fifty-six individuals with clinically node-negative CMHN, median Breslow thickness, 2.6 mm (range, 0.2-20.0 mm).


METHODS
Preoperative technetium 99m sulfur colloid lymphoscintigraphy (PLSG) followed within 4 hours by intraoperative handheld gamma probe localization (IHGP). Intraoperative injection of 1% isosulfan blue dye (IBD) was used in 48 patients. Immediate completion nodal dissection was performed for metastatic SLNs on intraoperative frozen section analysis and monitoring for negative SLNs.


METHODS
Rate of SLN identification, SLN and non-SLN positivity, same-basin recurrence, and disease-specific and recurrence-free survival.


RESULTS
Combination of IHGP and IBD improved SLN identification to 96% from 93% for IHGP and 73% for IBD alone. Four patients had a positive SLN on frozen section analysis. A negative SLNB correctly predicted regional nodal control in 47 of 48 patients but missed 1 of 5 patients who had regional lymphatic disease. All 4 patients who failed SLNB remain alive and free of recurrent disease. Two-year Kaplan-Meier disease-specific and relapse-free survival was 91% and 88%, respectively. Two-year disease-specific survival was 93% for SLN-negative patients and 50% for SLN-positive patients (P=.20).


CONCLUSIONS
Combining PLSG with IHGP and IBD improves the success rate of SLNB. Although SLNB is a reliable indicator of the status of the draining lymphatic basins in CMHN, patients with negative SLNs must be observed for longer periods to understand the true implications of the procedure.
Patel
Snehal G
SG
Head and Neck Service, PO Box 285, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Coit
Daniel G
DG
Shaha
Ashok R
AR
Brady
Mary Sue
MS
Boyle
Jay O
JO
Singh
Bhuvanesh
B
Shah
Jatin P
JP
Kraus
Dennis H
DH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005629:Frozen Sections; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology*; D015996:Survival Rate; D013671:Technetium Tc 99m Sulfur Colloid
D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid