title: Lower prevalence of lymphatic metastasis and poorer survival of the sentinel node-negative patients limit the prognostic value of sentinel node biopsy for head or neck melanomas.
abstract: Head or neck location of primary cutaneous melanomas has been described as an adverse prognostic factor, but this has to be reassessed after the introduction of sentinel lymph node (SLN) excision (SLNE). Descriptive statistics, Kaplan-Meier estimates and Cox proportional hazard models were used to study retrospectively a population of 2302 consecutive melanoma patients from three German melanoma centres undergoing SLNE. Approximately 10% of the patients (N=237) had a primary melanoma located at the head or neck (HNM). In both the SLN-positive and SLN-negative subpopulation, patients with HNM were significantly older, more frequently men and had thicker primaries compared with patients with tumours in other locations. The proportion of positive SLNs was lower in HNM compared with other locations of the primary (20 vs. 26%, P=0.048). The false-negative rate was higher in HNM (17.5 vs. 8.4%, P=0.05). In patients with HNM, the SLN status was a significant factor for recurrence-free survival but not for overall survival. SLN-negative HNM patients had a significantly worse overall survival than the SLN negatives with primaries at other sites, whereas the prognosis of the SLN-positive patients was similar in both groups. The prevalence of lymph node metastases after SLNE is lower in patients with HNM compared with other melanoma locations. As a result, the prognostic information provided by the SLN for HNM seems less important. Decision making for SLNE in HNM should be carefully balanced considering the potential morbidity of the procedure.
authors.affiliation: aDepartment of Dermatology and Allergy, Hannover Medical School, Skin Cancer Center Hannover, Hannove bDepartment of Dermatology and Allergology, Klinikum Augsburg, Augsburg cDepartment of Dermatology, Venereology and Allergology, Georg August University, Göttingen dDepartment of Dermatology, Venereology and Allergology, Klinikum Hildesheim GmbH, Hildesheim, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Al Ghazal
authors.forename: Ralf
authors.initials: R
authors.lastname: Gutzmer
authors.forename: Imke
authors.initials: I
authors.lastname: Satzger
authors.forename: Hans
authors.initials: H
authors.lastname: Starz
authors.forename: Christina
authors.initials: C
authors.lastname: Bader
authors.forename: Kai-Martin
authors.initials: KM
authors.lastname: Thoms
authors.forename: Christina
authors.initials: C
authors.lastname: Mitteldorf
authors.forename: Michael P
authors.initials: MP
authors.lastname: Schön
authors.forename: Alexander
authors.initials: A
authors.lastname: Kapp
authors.forename: Hans P
authors.initials: HP
authors.lastname: Bertsch
authors.forename: Lutz
authors.initials: L
authors.lastname: Kretschmer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma