title: Dilemma of clinically node-negative head and neck melanoma: outcome of "watch and wait" policy, elective lymph node dissection, and sentinel node biopsy--a systematic review.
abstract: The management of patients with clinically node-negative melanoma of the head and neck remains controversial. This is a systematic review of management strategies for stage I head and neck melanoma. Subgroup analysis of 1 randomized controlled trial (RCT) and most available cohort studies do not reveal a significant impact of elective neck dissection on survival. For 1.2- to 3.5-mm-thick melanoma at all anatomical sites, 1 RCT does not show an overall significant melanoma-specific survival benefit of sentinel node biopsy, but subgroup analysis suggests a survival benefit for lymph node-positive patients, confirming findings from 3 retrospective series. Sentinel node biopsy in the head and neck region can be technically demanding, with lower identification rates and higher false-negative rates. There is no conclusive survival advantage of either elective neck dissection or sentinel node biopsy in patients with clinically node-negative head and neck melanoma of intermediate thickness.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. P.J.Tanis@amc.uva.nl
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Omgo E
authors.initials: OE
authors.lastname: Nieweg
authors.forename: Michiel W M
authors.initials: MW
authors.lastname: van den Brekel
authors.forename: Alfons J M
authors.initials: AJ
authors.lastname: Balm
mesh_terms: D003657:Decision Making; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D037981:Neck Dissection; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis