title: Idiosyncrasies of scalp melanoma.
abstract: OBJECTIVE
  Examine the accuracy of sentinel lymph node biopsy (SNB) in scalp melanoma (SM), patterns of nodal metastases, patient outcomes, and the utility of immunohistochemistry (IHC) in SNB evaluation.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  There were 22 patients, 4 females and 18 males. Sentinel lymph nodes (SLN) were localized via preoperative lymphoscintigraphy, intraoperative gamma probe, and Lymphazurin injection. SLNs were stained with hematoxylin-eosin, S-100, HMB-45, Melan-A, micropthalmia transcription factor, and tyrosinase. SLNs were grouped into cervical (levels 1-5) and extracervical (parotid, suboccipital, retroauricular) regions.
  
  
  RESULTS
  There were 13 posterior and 9 anterior SMs. The first SNB were mapped to the extracervical regions in 77% of posterior and 78% of anterior lesions. SLN number ranged from 1 to 5. Ten patients had positive SLNs (PSLN). Forty percent of the PSLN group had SLNs mapped in both cervical and extracervical sites. Six underwent completion lymphadenectomy, with no additional positive nodes identified. No significant difference between PSLN and negative sentinel node (NSLN) patients was seen when compared by SLN number, Breslow's thickness, tumor ulceration, and clinical outcomes. Mean follow-up was 35 months. One patient died of disease. One isolated regional recurrence occurred. Sixty percent of PSLN and 92% of NSLN patients were recurrence free at last follow-up. One distant metastasis occurred in the NSLN group, and one local, one regional, and two patients with distant metastases were in the PSLN group at the time of last follow-up. Additional IHC did not detect other metastases in the NSLN group.
  
  
  CONCLUSIONS
  SM is aggressive, as demonstrated by the high rate of SLN metastases, and there were no significant histopathologic factors in the primary tumor that predicted the presence of SLN metastases. SNB was accurate. The majority of first SLNs were localized in extracervical basins.
authors.affiliation: Department of Head and Neck Surgery, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York 14263, USA. nestor.rigual@roswellpark.org
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Rigual
authors.forename: Richard T
authors.initials: RT
authors.lastname: Cheney
authors.forename: Obiajulu H
authors.initials: OH
authors.lastname: Iwenofu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Thom R
authors.initials: TR
authors.lastname: Loree
authors.forename: Saurin R
authors.initials: SR
authors.lastname: Popat
authors.forename: Mihai
authors.initials: M
authors.lastname: Merzianu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000276:immunology / Q000378:metabolism; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D058965:MART-1 Antigen; D008297:Male; D008545:Melanoma / Q000276:immunology / Q000378:metabolism / Q000556:secondary*; D058950:Melanoma-Specific Antigens; D051739:Microphthalmia-Associated Transcription Factor / Q000378:metabolism; D008875:Middle Aged; D014442:Monophenol Monooxygenase / Q000378:metabolism; D009333:Neck; D009363:Neoplasm Proteins / Q000378:metabolism; D011379:Prognosis; D012189:Retrospective Studies; D009418:S100 Proteins / Q000378:metabolism; D012535:Scalp; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000276:immunology / Q000378:metabolism / Q000473:pathology*
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D058965:MART-1 Antigen; C548667:MLANA protein, human; D058950:Melanoma-Specific Antigens; D051739:Microphthalmia-Associated Transcription Factor; D009363:Neoplasm Proteins; D009418:S100 Proteins; D014442:Monophenol Monooxygenase