title: Completion node dissection in patients with sentinel node-positive melanoma of the head and neck.
abstract: OBJECTIVE
  Determine if completion lymph node dissection (CLND) is associated with improved survival in sentinel lymph node (SLN)-positive cutaneous melanoma of the head and neck (CMHN) patients.
  
  
  METHODS
  Retrospective analysis of large population database.
  
  
  METHODS
  Surveillance, Epidemiology and End Results (SEER) database/multiple settings.
  
  
  METHODS
  Using the SEER database, the authors identified patients with SLN-positive CMHN. Clinicopathologic data and 5-year disease-specific survival (DSS) were examined for patients who underwent sentinel lymph node biopsy (SLNB) alone vs SLNB + CLND.
  
  
  RESULTS
  Among 350 SLN-positive patients, 210 (60%) had SLNB + CLND, and 140 (40%) had SLNB only. Patients in the SLNB-only group were significantly older (median age 62 vs 53 years, P < .0001). The cohort as a whole did not significantly benefit from CLND; however, CLND was associated with improved DSS for a subgroup of patients age <60 years with nonulcerated tumors ≤ 2 mm thick (P = .03). Relative to SLNB alone, CLND did not improve survival for patients age ≥ 60 years or those with thicker (>2 mm) or ulcerated tumors.
  
  
  CONCLUSIONS
  Compared with SLNB alone, CLND does not seem to be associated with improved survival for most patients with SLN-positive CMHN. CLND likely improves survival for patients age <60 years with thin (≤ 2 mm) nonulcerated tumors and when there is a low risk of identifying positive non-SLNs.
authors.affiliation: College of Medicine, Medical University of South Carolina, Charleston, South Carolina 29425-5500, USA.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Smith
authors.forename: Joan E
authors.initials: JE
authors.lastname: Cunningham
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lentsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008545:Melanoma / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate