title: Assessment of second tier lymph nodes in melanoma and implications for extent of elective neck dissection in metastatic cutaneous malignancy of the parotid.
abstract: BACKGROUND
  The parotid is the commonest site of cutaneous metastases in the head and neck. The role and extent of neck dissection in patients with parotid metastatic cutaneous malignancy remains controversial.
  
  
  METHODS
  We reviewed the lymphoscintigraphy and single photon emission CT (SPECT) of patients with melanoma who had a sentinel node in the parotid to determine the second tier cervical lymph nodes.
  
  
  RESULTS
  Levels II and III cervical nodes make up 82% of second tier lymph nodes for the parotid, and levels IV and V, 12% and 4%, respectively. Second tier lymph nodes isolated to levels I, IV, or V, bypassing levels II and III, occurred in only 2% of cases.
  
  
  CONCLUSIONS
  The risk of harboring occult metastasis in levels I, IV, and V when levels II and III are negative is low. Levels II and III neck dissection is likely to be an effective staging procedure in patients with isolated parotid metastases.
authors.affiliation: The Sydney Head & Neck Cancer Institute, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, New South Wales, Australia. snchng@xtra.co.nz
authors.forename: Sydney
authors.initials: S
authors.lastname: Ch'ng
authors.forename: Audrey
authors.initials: A
authors.lastname: Pinna
authors.forename: Kim
authors.initials: K
authors.lastname: Ioannou
authors.forename: Karolina
authors.initials: K
authors.lastname: Juszczyk
authors.forename: Kerwin
authors.initials: K
authors.lastname: Shannon
authors.forename: Anthony
authors.initials: A
authors.lastname: Clifford
authors.forename: Roger
authors.initials: R
authors.lastname: Uren
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D064847:Multimodal Imaging; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods*; D010307:Parotid Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D049268:Positron-Emission Tomography; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome