Open AccessSentinel Lymph Node Biopsy in Head and Neck Melanoma: Long‐term Outcomes, Prognostic Value, Accuracy, and Safety
Author(s) -
Hanks John E.,
Kovatch Kevin J.,
Ali S. Ahmed,
Roberts Emily,
Durham Alison B.,
Smith Joshua D.,
Bradford Carol R.,
Malloy Kelly M.,
Boonstra Philip S.,
Lao Christopher D.,
McLean Scott A.
Publication year - 2020
Publication title -
otolaryngology–head and neck surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.232
H-Index - 121
eISSN - 1097-6817
pISSN - 0194-5998
DOI - 10.1177/0194599819899934
Subject(s) - medicine , sentinel lymph node , hazard ratio , cohort , surgery , biopsy , retrospective cohort study , melanoma , lymph node , cancer , breast cancer , confidence interval , cancer research
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.