A definitive role for sentinel lymph node mapping with biopsy for cutaneous melanoma of the head and neck

Aims: The aim of this study was to evaluate the role, if any, of sentinel lymph node mapping (SLNM) with biopsy (SLNB) in patients with cutaneous melanoma of the head and neck. Methods: Consecutive patients with cutaneous melanoma of the head and neck regions undergoing SLNM with biopsy were identified from a departmental database comprising 480 patients in total from 2000-2007. Factors examined included demographic data, histological subtype, site and depth of lesion, pre-operative lymphoscintigraphy, percentage of positive SLNs, regional recurrence in the setting of a negative SLNB result (false-negative rate), complications, further lymphadenectomy, percentage of skin grafting required and follow-up. Results: The median patient age was 51 years (range 18-90 years). The mean Breslow depth was 3.25mm (range 1-19mm). Five patients presented with stage III/IV disease. A SLN was identified in 27/40 patients who underwent head and neck SLN mapping (mean two lymph nodes per patient). Of these, six (22%) patients were positive for metastatic melanoma. The false-negative rate was 9.5%. The median follow up for patients was 39.6 months (range 12-96 months). No facial nerve injury or other major morbidity occurred. Conclusions: This study indicates that SLNB is a reliable and safe technique to diagnose regional spread from head and neck cutaneous melanoma. It is more difficult than at other sites. These lesions have a higher incidence of failed SLN mapping and a higher rate of recurrence following negative SLNB, when compared to truncal and extremity lesions. Nodular melanomas are more likely to fail the sentinel lymph node mapping procedure than other histological subtypes.