title: Regional control of head and neck melanoma with selective neck dissection.
abstract: OBJECTIVE
  Historically, patients with cervical metastases from melanoma of the head and neck were treated with a radical neck dissection. This study evaluates the efficacy of limiting the extent of lymphadenectomy in this high-risk population.
  
  
  OBJECTIVE
  To determine whether limiting the extent of lymphadenectomy for patients with biopsy-proven melanoma has a negative effect on regional control. Our hypothesis was that performing a more limited lymphadenectomy does not have a negative impact on regional control.
  
  
  METHODS
  A retrospective, single-cohort study was performed using a prospectively collected database of patients with head and neck melanoma with histopathologically positive lymph nodes after modified radical (MRND) or selective neck dissection (SNDs) performed at a high-volume, academic, tertiary care center.
  
  
  METHODS
  Lymphadenectomy was performed as clinically indicated.
  
  
  METHODS
  Primary end points were regional recurrence and regional recurrence free survival. Univariable and multivariable analyses were conducted using multiple patient characteristics.
  
  
  RESULTS
  Forty-one patients underwent SND or MRND from 2001 through 2010. The median number of positive nodes was 1 (range, 1-16). Twenty-six patients (63%) received adjuvant radiation and 23 patients (56%) received adjuvant immunotherapy or chemotherapy. The median follow-up time was 17 months (range, 1-116 months). Regional control was achieved in 29 patients (71%). Median regional recurrence-free survival was 21 months (range, 1-116 months). Age (hazard ratio [HR], 1.13; 95% CI, 1.01-1.26), total number of nodes examined (HR, 1.05; 95% CI, 1.01-1.10), and number of sentinel lymph nodes examined (HR, 1.45; 95% CI, 1.01-2.09) were all significantly associated with increased recurrence-free survival. Tumor depth, extracapsular spread, number of nodes positive, prior SLNB, extent of lymphadenectomy, and adjuvant therapy were not significant.
  
  
  CONCLUSIONS
  Limiting the extent of lymphadenectomy with frequent use of adjuvant radiation therapy is effective in achieving regional control of head and neck melanoma with cervical metastases.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Mathew
authors.initials: M
authors.lastname: Geltzeiler
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Marcus
authors.initials: M
authors.lastname: Monroe
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Babak
authors.initials: B
authors.lastname: Givi
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland.
authors.forename: John
authors.initials: J
authors.lastname: Vetto
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Peter
authors.initials: P
authors.lastname: Andersen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
authors.forename: Neil
authors.initials: N
authors.lastname: Gross
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D004428:Ear Neoplasms / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012535:Scalp; D012878:Skin Neoplasms / Q000601:surgery*; D055815:Young Adult