title: Sentinel Lymph Node Biopsy Provides Prognostic Value in Thick Head and Neck Melanoma.
abstract: OBJECTIVE
  Sentinel lymph node biopsy (SLNB) is standard practice for intermediate-thickness head and neck melanoma (HNM) but remains controversial for melanomas more than 4 mm in thickness. The objectives of this study were to evaluate (1) the diagnostic accuracy and (2) the prognostic value of SLNB in patients with thick HNM.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Large cancer center between June 2000 and December 2012.
  
  
  METHODS
  77 patients undergoing SLNB for T4 HNM without in-transit, regional, or distant metastatic disease at presentation.
  
  
  METHODS
  Univariate and multivariate analyses of prognostic factors were performed.
  
  
  RESULTS
  77 patients underwent attempted SLNB for T4 HNM without in-transit, regional, or distant metastatic disease at presentation. The mean patient age was 62 years (range, 4-87 years) and there was a male predominance (80%). Mean Breslow thickness was 6.1 mm (range, 4-21 mm). Of the 77 patients undergoing attempted SLNB, 7 had no identifiable sentinel lymph node (9%). For the remaining 91% with 1 or more identifiable sentinel lymph nodes, the mean number of nodes identified was 3.3 (range, 1-13). The sentinel lymph node positivity rate was 24%. A false-negative SLNB occurred in 2 patients (3.8%). With a median follow-up of 36 months, the estimated 5-year disease-free, disease-specific, and overall survival rates were 47%, 74%, and 69%, respectively. A positive sentinel lymph node was significantly linked to shortened disease-free survival (74 vs 36 months, P = .026) and disease-specific survival (121 vs 59 months, P = .035).
  
  
  CONCLUSIONS
  SLNB provides accurate staging of the regional node basin and important prognostic information for patients with thick HNM.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA marcus.monroe@hsc.utah.edu.
authors.forename: Marcus M
authors.initials: MM
authors.lastname: Monroe
authors.affiliation: School of Medicine, University of Texas at Houston, Houston, Texas, USA.
authors.forename: Prasanth
authors.initials: P
authors.lastname: Pattisapu
authors.affiliation: Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Myers
authors.affiliation: Department of Head and Neck Surgery, the University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kupferman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate
keywords: NCCN; T4; adjuvant; cutaneous; eyelid; face; guidelines; head and neck; lymphatic; malignancy; melanoma; metastasis; neck; prognosis; scalp; sentinel lymph node biopsy; skin cancer; staging; thick