Impact of sentinel node status and other risk factors on the clinical outcome of head and neck melanoma patients.
OBJECTIVE
To determine the impact of sentinel lymph node (SLN) status and other risk factors on recurrence and overall survival in head and neck melanoma patients.


METHODS
The SLN Working Group, based in San Francisco, Calif, with its 11 member centers, the John Wayne Cancer Institute, and The University of Texas M. D. Anderson Cancer Center pooled data on 629 primary head and neck melanoma patients who had selective sentinel lymphadenectomy. A total of 614 subjects were analyzable. All centers obtained internal review board approval and adhered to the Health Insurance Portability and Accountability Act of 1996 regulations. A Cox proportional hazards model was used to identify factors associated with overall and disease-free survival.


METHODS
Tertiary care medical centers.


METHODS
Clinical outcome of head and neck melanoma patients undergoing selective sentinel lymphadenectomy.


RESULTS
Overall, 10.1% (n = 62) of the subjects had at least 1 positive node. Subjects with positive SLN status had significantly thicker tumors (mean thickness, 2.8 vs 2.1 mm; P < .001), and were more likely to have ulcerated tumors (P = .004). During the median follow-up of 3.3 years, the overall mortality from head and neck melanoma was 10%, with more than 20% experiencing at least 1 recurrence. Multivariate analysis showed that tumor site was an independent predictor of mortality; location on the scalp had a more than 3-fold (P < .001) greater mortality than tumors on the face. Tumor thickness was also an independent predictor of overall survival, and SLN status was the most important predictor of disease-free survival in the multivariate model (P < .001). Tumors on the scalp had the highest rate of recurrence, while those on the neck had the lowest. Tumor ulceration was the significant predictor of time to recurrence or disease-free survival (P < .001).


CONCLUSIONS
In this multicenter study, SLN status and other risk factors have an effect on recurrence and/or overall survival.
Leong
Stanley P L
SP
Department of Surgery, University of California, San Francisco, CA 94115, USA. leongs@surgery.ucsf.edu
Accortt
Neil A
NA
Essner
Richard
R
Ross
Merrick
M
Gershenwald
Jeffrey E
JE
Pockaj
Barbara
B
Hoekstra
Harald J
HJ
Garberoglio
Carlos
C
White
Richard L
RL
Chu
David
D
Biel
Merrill
M
Charney
Kim
K
Wanebo
Harold
H
Avisar
Eli
E
Vetto
John
J
Soong
Seng-Jaw
SJ
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D014481:United States / Q000453:epidemiology