title: Association of sentinel lymph node biopsy with survival for head and neck melanoma: survival analysis using the SEER database.
abstract: OBJECTIVE
  Sentinel lymph node biopsy (SLNB) provides prognostic information for melanoma; however, a survival benefit has not been demonstrated.
  
  
  OBJECTIVE
  To assess the association of SLNB with survival for melanoma arising in head and neck subsites (HNM).
  
  
  METHODS
  Propensity score-matched retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database to compare US patients with HNM meeting current recommendations for SLNB, treated from 2004 to 2011 with either (1) SLNB with or without neck dissection, or (2) no SLNB or neck dissection.
  
  
  METHODS
  SLNB with or without neck dissection.
  
  
  METHODS
  Disease-specific survival (DSS) estimates based on the Kaplan-Meier method, and Cox proportional hazards modeling to compare survival outcomes between matched pair cohorts.
  
  
  RESULTS
  A total of 7266 patients with HNM meeting study criteria were identified from the SEER database. Matching of treatment cohorts was performed using propensity scores modeled on 10 covariates known to be associated with SLNB treatment or melanoma survival. Cohorts were stratified by tumor thickness (thin, >0.75-1.00 mm Breslow thickness; intermediate, >1.00-4.00 mm; and thick, >4.00 mm) and exactly matched within 5 age categories. In the intermediate-thickness cohort, 2808 patients with HNM were matched and balanced by propensity score for SLNB treatment; the 5-year DSS estimate for those treated by SLNB was 89% vs 88% for nodal observation (log-rank P = .30). The hazard ratio for melanoma-specific death was 0.87 for those undergoing SLNB (95% CI, 0.66-1.14; P = .31). In each of the other cohorts analyzed, including those with thin and thick melanomas, and cohorts with melanoma overall, no significant difference in DSS was demonstrated.
  
  
  CONCLUSIONS
  This SEER cohort analysis demonstrates no significant association between SLNB and improved disease-specific survival for patients with HNM.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Sperry
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, Iowa City.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Charlton
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City.
authors.forename: Nitin A
authors.initials: NA
authors.lastname: Pagedar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D037981:Neck Dissection; D012189:Retrospective Studies; D018426:SEER Program; D021701:Sentinel Lymph Node Biopsy; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D055815:Young Adult