Sentinel Lymph Node Biopsy in Head and Neck Cutaneous Malignant Melanoma

Abstract

Introduction: Sentinel lymph node biopsy (SLNB) is the standard of care for cutaneous melanoma, including head and neck melanoma. The aim of this study was to analyze and characterize SLNB in a population of head and neck melanoma patients. Methods: A unicentric, retrospective study on patients with cutaneous head and neck melanoma who underwent SLNB in the Department of Head and Neck Surgery at the Portuguese Institute of Oncology (IPO) Lisbon between January 2010 and December 2017 was performed. The location of primary melanoma, the identification of SLN, the number of the excised SLN, its lymphatic basin origin and the presence of infraclinic metastasis were analysed. Results:  Ninety-eight patients were eligible to undergo SLNB during the observation period. The most frequent locations of primary melanoma were the scalp (24.5%) and the auricular and periauricular region (23.5%) and the most frequent variants were the superficial spreading melanoma (40.8%) and nodular melanoma (30.6%). SLNB was successfully executed in 78 patients (79.6%). A mean of 3.8 lymph-nodes per patient were excised and in 16.7% SLN were excised in more than one lymphatic basin. The SLN were identified in parotid region (39.8%), level II (29.5%) and level V (18.2%). SLN metastases were detected in 13 patients (16.7%). Conclusion: Surgical approach of head and neck cutaneous melanoma is particularly complex. The redundancy of lymphatic system, the multiple SLN and SLN basins influence the SLNB success and may contribute to high rates of false-negatives with its prognostic implications. All patients should be carefully monitored.