title: Long-term prognosis and significance of the sentinel lymph node in head and neck melanoma.
abstract: OBJECTIVE
  To report the long-term significance of sentinel lymph node (SLN) biopsy on prognosis, determine false-negative SLN occurrences, and determine risk factors for death and recurrence in a large series of patients with head and neck melanoma.
  
  
  METHODS
  Case series with tumor registry review.
  
  
  METHODS
  Academic tertiary care medical center.
  
  
  METHODS
  A database review was performed of all patients who underwent SLN biopsy for head and neck melanoma from 1994 to 2009. End points assessed were SLN status, recurrence, false-negative SLN results, and survival comparing SLN-positive and SLN-negative patients and different locations. Survival curves and multivariate analyses were performed.
  
  
  RESULTS
  SLN biopsy was performed in 365 patients. SLNs were identified in 98.6% of patients with a mean of 3.7 nodes removed from 1.6 nodal basins per patient. Median follow-up was 8 years. The SLN was positive in 40 (11%) patients. SLN-positive patients had significantly thicker melanomas, higher recurrence (P < .0001), and a significant decrease in overall survival compared with SLN-negative patients (P < .002). Scalp melanoma patients had significantly thicker melanomas and an elevated risk of SLN positivity, recurrence, and death compared with other sites. Seventeen of 365 SLN-negative patients developed regional nodal disease for a false-omission rate of 5.2% and a negative predictive value of a negative SLN to be 94.8%. Risks for false negative-SLN occurrences included thick melanomas and scalp melanomas.
  
  
  CONCLUSIONS
  SLN biopsy is accurate in head and neck melanoma and provides significant prognostic data. Scalp melanoma patients present with thicker tumors with an increase in SLN positivity and false-negative SLN occurrences.
authors.affiliation: The Buncke Clinic, Division of Plastic Surgery, California Pacific Medical Center, San Francisco, California 94115, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Parrett
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kashani-Sabet
authors.forename: Mark I
authors.initials: MI
authors.lastname: Singer
authors.forename: Rui
authors.initials: R
authors.lastname: Li
authors.forename: Suresh
authors.initials: S
authors.lastname: Thummala
authors.forename: Niloofar
authors.initials: N
authors.lastname: Fadaki
authors.forename: Stanley P L
authors.initials: SP
authors.lastname: Leong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005188:False Negative Reactions; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D018709:Statistics, Nonparametric; D015996:Survival Rate