title: Sentinel lymph node biopsy for cutaneous melanoma of the head and neck.
abstract: BACKGROUND
  Lymph node status is the most important prognostic factor for patients with cutaneous melanoma. Sentinel lymph node biopsy (SLNB) is now the standard of care for staging clinically node-negative patients. It is accurate with low morbidity, yet SLNB for head and neck melanoma is challenging because of unpredictable lymphatic drainage and risk of complications.
  
  
  METHODS
  A retrospective analysis of prospectively collected data identified patients with cutaneous melanoma of the head and neck > or =.76 mm. Sentinel lymph nodes were identified by using a standardized protocol of preoperative lymphoscintigrams, intraoperative blue dye injections, and handheld gamma probes. Clinical, surgical, and pathologic data were collected and analyzed.
  
  
  RESULTS
  A sentinel lymph node was removed in 41 (94%) of 44 patients. Seven (17%) of 41 had at least 1 positive sentinel lymph node. Three of seven had primary tumors <1 mm (two of the three were not ulcerated). The sites of lymphatic drainage of the primary lesion were discordant, with historical anatomically predicted sites in 24.4% of cases. None of the 34 patients with negative SLNB has had a nodal recurrence (false-negative rate, 0%; sensitivity and negative predictive value, 100%). The mean follow-up is 22.4 months (range, <1-69 months). Seven (17%) of 41 patients had minor complications.
  
  
  CONCLUSIONS
  SLNB in the head and neck area is challenging; however, combined preoperative, intraoperative, and histological techniques produce a sensitive procedure with a high negative predictive value. The lack of false-negative results obviates the need for prophylactic neck dissections.
authors.affiliation: Department of Laboratory Medicine and Pathobiology, Banting Institute, 100 College Street, Room 110, Toronto, Ontario, M9G 1L5, Canada. karenmacneill@yahoo.com
authors.forename: Karen Nicole
authors.initials: KN
authors.lastname: MacNeill
authors.forename: Danny
authors.initials: D
authors.lastname: Ghazarian
authors.forename: David
authors.initials: D
authors.lastname: McCready
authors.forename: Lorne
authors.initials: L
authors.lastname: Rotstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*