Assessment of second tier lymph nodes in melanoma and implications for extent of elective neck dissection in metastatic cutaneous malignancy of the parotid

Ch’ng, Sydney; Pinna, Audrey; Ioannou, Kim; Juszczyk, Karolina; Shannon, Kerwin F.; Clifford, Anthony; Uren, Roger F.; Clark, Jonathan R.

doi:10.1002/hed.22948

Cited by 8 publications

(14 citation statements)

References 9 publications

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“…Currently, the presence of micrometastasis is an indication for nodal basin dissection and lymphadenectomy; although the MSLT‐II trial in melanoma aims to answer whether SNB is adequate without definitive nodal basin clearance, such refinements of surgical treatment have not been trialed in cutaneous SCC and 20% of patients in this series had additional disease on completion neck dissection. The use of lymphoscintigraphy is critical to guide therapeutic nodal dissections because the pattern of drainage is not predictable from cutaneous sites unless the first nodal echelon is known …”

Section: Discussionmentioning

confidence: 99%

“…“High‐risk” cutaneous SCC has a reported lymph node metastasis rate of up to 37%, depending on the risk criteria used . Once patients have developed lymphatic metastasis, the recurrence rate after surgery approximates 30% and 5‐year survival rates after recurrence drop below 50% . Postoperative radiotherapy is believed to improve locoregional control, and the POST study is investigating the utility of postoperative concurrent chemotherapy and radiotherapy .…”

Section: Introductionmentioning

confidence: 99%

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Prospective study of sentinel node biopsy for high‐risk cutaneous squamous cell carcinoma of the head and neck

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prospective study of sentinel node biopsy for high‐risk cutaneous squamous cell carcinoma of the head and neck

et al. 2015

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“…The region of the external jugular lymph node adjacent to the tail of the parotid is critical [21] . Although lymphatic drainage from cutaneous tumors is unpredictable, in patients with parotid metastases, there is considerable evidence that the location of the metastases is predictive of further potential sites of nodal disease [22,23] . Routine preoperative investigations of patients with suspected parotid nodal metastases include ultrasound guided fine-needle aspiration and CT scanning of the parotid gland, neck and chest.…”

Section: Surgical Management Of Nodal Metastases To the Parotid Glandmentioning

confidence: 99%

“…Surgery is directed at all likely involved nodes, and thus, cervical lymphadenectomy tends to be more comprehensive for melanoma compared to CSCC [35,53] . However, selective options may be appropriate, for example, the omission of level I when the primary tumor is located in the posterior scalp or neck and the omission of level V when the anterior face is the primary location.…”

Section: Elective Neck Management For Melanoma Metastatic To the Parotidmentioning

confidence: 99%

Metastatic Cancer to the Parotid

Clark

Wang

2016

Salivary Gland Neoplasms

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In many regions of the world, the most common type of parotid malignancy is metastatic malignancy. Metastatic cutaneous squamous cell carcinoma and metastatic melanoma are the most common pathologies that metastasize to the parotid gland and cervical lymph nodes. Other more rare metastatic malignancies from cutaneous primary sites include Merkel cell carcinoma, pleomorphic sarcoma (previously called malignant fibrous histiocytoma) and metastatic basal cell carcinoma. Systemic metastases can also occur from tumors such as renal cell carcinoma. This review will focus on the management of the two most common causes of parotid malignancy.

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“…Based on the observed pattern of metastasis, several authors have hypothesized that the use of a selective neck dissection could be justified in patients without clinical neck disease . Shah et al suggested that selective dissection might be based on the location of the primary tumor.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of the neck in patients with metastatic melanoma in parotid lymph nodes

Hondt

Starr

Millett

et al. 2019

Journal of Surgical Oncology

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Background The role and extent of neck dissection in patients with parotid metastatic cutaneous head and neck melanoma remain unclear. The aims of this study were to determine the incidence and patterns of cervical node involvement in patients with parotid metastatic melanoma, and to determine if a limited lymphadenectomy of the clinically negative neck is appropriate. Methods Patients who underwent parotidectomy and neck dissection for clinically apparent parotid metastatic melanoma, irrespective of neck status, were identified from two prospectively maintained databases. Results A total of 276 patients fulfilled the study criteria. Median follow‐up was 23 months. A total of 185 necks were clinically negative, 82 were clinically positive. A total of 36 elective neck‐dissection specimens harbored occult metastases; these were found in levels I (16.7%), II (58.3%), III (36.1%), IV (13.9%), and V (30.6%). Regional recurrence occurred in 32 patients with a clinically negative neck, the majority being in‐transit metastases (n = 15). Only one case of recurrence could have potentially been avoided by a comprehensive lymphadenectomy. Conclusions In patients with clinically apparent parotid melanoma metastases, elective comprehensive neck dissection reduces failure rates in cervical nodes, and provides more accurate staging and prognostic information. However, our findings support the emerging trend for more limited elective neck dissection. Levels I and IV can probably be safely omitted.

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Assessment of second tier lymph nodes in melanoma and implications for extent of elective neck dissection in metastatic cutaneous malignancy of the parotid

Abstract: The risk of harboring occult metastasis in levels I, IV, and V when levels II and III are negative is low. Levels II and III neck dissection is likely to be an effective staging procedure in patients with isolated parotid metastases.

Cited by 8 publications

References 9 publications

Prospective study of sentinel node biopsy for high‐risk cutaneous squamous cell carcinoma of the head and neck

Prospective study of sentinel node biopsy for high‐risk cutaneous squamous cell carcinoma of the head and neck

Metastatic Cancer to the Parotid

Surgical management of the neck in patients with metastatic melanoma in parotid lymph nodes

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