Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Long‐term Outcomes, Prognostic Value, Accuracy, and Safety
John E. Hanks, Kevin J. Kovatch, S. Ahmed Ali, Emily Roberts, Alison B. Durham, Joshua D. Smith, Carol R. Bradford, Kelly M. Malloy, Philip S. Boonstra, Christopher D. Lao, Scott A. McLean
Abstract
Objective To evaluate the long‐term outcomes of sentinel lymph node biopsy (SLNB) for head and neck cutaneous melanoma (HNCM). Study Design Retrospective cohort study. Setting Tertiary academic medical center. Subjects and Methods Longitudinal review of a 356‐patient cohort with HNCM undergoing SLNB from 1997 to 2007. Results Descriptive characteristics included the following: age, 53.5 ± 19 years (mean ± SD); sex, 26.8% female; median follow‐up, 4.9 years; and Breslow depth, 2.52 ± 1.87 mm. Overall, 75 (21.1%) patients had a positive SLNB. Among patients undergoing completion lymph node dissection following positive SLNB, 20 (27.4%) had at least 1 additional positive nonsentinel lymph node. Eighteen patients with local control and negative SLNB developed regional disease, indicating a false omission rate of 6.4%, including 10 recurrences in previously unsampled basins. Ten‐year overall survival (OS) and melanoma‐specific survival (MSS) were significantly greater in the negative sentinel lymph node (SLN) cohort (OS, 61% [95% CI, 0.549‐0.677]; MSS, 81.9% [95% CI, 0.769‐0.873]) than the positive SLN cohort (OS, 31% [95% CI, 0.162‐0.677]; MSS, 60.3% [95% CI, 0.464‐0.785]) and positive SLN/positive nonsentinel lymph node cohort (OS, 8.4% [95% CI, 0.015‐0.474]; MSS, 9.6% [95% CI, 0.017‐0.536]). OS was significantly associated with SLN positivity (hazard ratio [HR], 2.39; P <. 01), immunosuppression (HR, 2.37; P <. 01), angiolymphatic invasion (HR, 1.91; P <. 01), and ulceration (HR, 1.86; P <. 01). SLN positivity (HR, 3.13; P <. 01), angiolymphatic invasion (HR, 3.19; P <. 01), and number of mitoses ( P =. 0002) were significantly associated with MSS. Immunosuppression (HR, 3.01; P <. 01) and SLN status (HR, 2.84; P <. 01) were associated with recurrence‐free survival, and immunosuppression was the only factor significantly associated with regional recurrence (HR, 6.59; P <. 01). Conclusions Long‐term follow up indicates that SLNB showcases durable accuracy, safety, and prognostic importance for cutaneous HNCM.