title: Excision margins and sentinel lymph node status as prognostic factors in thick melanoma of the head and neck: A retrospective analysis.
abstract: Recommended margins for thick cutaneous melanoma (Breslow thickness >4 mm; T4) have decreased over recent decades. Optimal margins and the role of sentinel node biopsy (SNB) in thick head and neck melanoma remain controversial.
  
  
  
  A single-center review was conducted of patients treated between 2002 and 2012 assessing the impact of excision margins and sentinel lymph node status on locoregional recurrence and melanoma-specific survival (MSS).
  
  
  
  One hundred eight patients were identified. Median age was 71.1 years and median Breslow thickness was 6.0 mm. Median follow-up was 40 months. Locoregional recurrence occurred in 27% and there was no significant reduction in recurrence with margins ≥2 cm (p = .17). Increasing margins did not improve survival (p = .58). Fifty-nine patients (55%) underwent SNB, of which 27% were positive. There was a trend toward longer survival for patients who were sentinel lymph node-negative (p = .097).
  
  
  
  Wider margins do not significantly improve locoregional recurrence or MSS. Sentinel lymph node involvement reflects a poor prognosis. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1373-1379, 2016.
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Olivia
authors.initials: O
authors.lastname: Ruskin
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sanelli
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Herschtal
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Webb
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Dixon
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Miklos
authors.initials: M
authors.lastname: Pohl
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Donahoe
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Spillane
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Henderson
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Australia.
authors.forename: David E
authors.initials: DE
authors.lastname: Gyorki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002173:Cancer Care Facilities; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008545:Melanoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D000071036:Sentinel Lymph Node / Q000473:pathology* / Q000601:surgery; D021701:Sentinel Lymph Node Biopsy / Q000379:methods; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma
keywords: head and neck; margins; melanoma; sentinel lymph node; thick