Does the number of sentinel lymph nodes removed affect the false negative rate for head and neck melanoma?

Puza, Charles J.; Josyula, Srirama; Terando, Alicia M.; Howard, John H.; Agnese, Doreen M.; Mosca, Paul J.; Lee, Walter T.; Beasley, Georgia M.

doi:10.1002/jso.25025

Cited by 15 publications

(10 citation statements)

References 19 publications

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“…Melanoma traditionally affects males at almost twice the rate of women and most often occurs on sun‐exposed regions of the body 28 . The demographic makeup of our study is congruent with those previously reported concerning advanced age and preponderance of males 16,20,22,29 . The majority of patients included in this analysis were found to have an increased mitotic rate, T stage >T1, and Clark's level > 3.…”

Section: Discussionsupporting

confidence: 89%

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Head & neck melanoma: A 22‐year experience of recurrence following sentinel lymph node biopsy

Echanique

Ghazizadeh

Moon

et al. 2021

Laryngoscope Investig Oto

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Objective To examine the clinicopathologic factors that contribute to regional and distant recurrence in intermediate to high risk head and neck melanoma patients after sentinel lymph node biopsy (SLNB). Methods This study is a retrospective review from an academic tertiary care center. Patients treated with SLNB for head and neck melanoma from 1997 to 2019 were reviewed and characterized by sentinel lymph node (SLN) status. Clinical variables were examined for the impact on regional and distant recurrence in SLNB‐negative patients using univariable and multivariable Cox regression analysis. Results One hundred and fifty four patients were included. Of note, 127 (82.5 %) were men, and the average age was 61.3 years. Median follow‐up was 68.6 weeks. Pathologic review of SLNs found 3.9% positive for metastatic melanoma; 96.1% were negative. Regional recurrence was significantly associated with tumor stage and age on multivariate analysis. A total of 4.5% of patients recurred in a previously labeled negative basin. Scalp subsite accounted for 30.5% of primary tumors and was more likely to yield a positive SLN on univariate analysis (P = .023). Tumor stage and age were significantly associated with distant metastasis on multivariable analysis (P = .026, P < .001 respectively). Conclusion We report a number of prognostic trends in head and neck melanoma. SLN positivity was found more often in patients with a primary tumor of the scalp. Regional recurrence was significantly associated with age and tumor stage, whereas distant recurrence was significantly associated with tumor staging and scalp subsite. Scalp subsite was associated with an increased risk for nodal metastasis and distant recurrence. Level of evidence 3.

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Section: Discussionsupporting

confidence: 89%

“… 28 The demographic makeup of our study is congruent with those previously reported concerning advanced age and preponderance of males. 16 , 20 , 22 , 29 The majority of patients included in this analysis were found to have an increased mitotic rate, T stage >T1, and Clark's level > 3.…”

Section: Discussionmentioning

confidence: 96%

Head & neck melanoma: A 22‐year experience of recurrence following sentinel lymph node biopsy

Echanique

Ghazizadeh

Moon

et al. 2021

Laryngoscope Investig Oto

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“…In addition, performance of sentinel lymph node biopsy (SLNB), which is useful for control of recurrence and regional disease, often is challenging in patients with HNM and often produces false-negative results. 32-37…”

Section: Discussionmentioning

confidence: 99%

The National Cancer Database: Survival Between Head and Neck Melanoma and Melanoma of Other Regions

Cabrera

Conic

et al. 2021

Otolaryngol.--head neck surg.

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Objective Primary site is considered an important prognostic factor for cutaneous malignant melanoma (CMM); however, opinions vary regarding its influence on survival. This study compares overall survival between head and neck melanoma (HNM) and melanoma of other regions (MOR), as well as between melanoma of the scalp and neck (MSN) and melanoma of other head regions (MOHR). Study Design Level III retrospective cohort study. Setting Patients from Commission on Cancer–accredited cancer programs affiliated to the National Cancer Database (NCDB). Methods Patients with HNM (MSN and MOHR included) and MOR, stages I to IV (n = 39,754), and their linked survival data using the NCDB were identified. Survival was analyzed using propensity score matching methods. Results After matching using propensity scores, allowing this observational study to mimic a randomized controlled trial, subjects with HNM showed a 22% increased mortality when compared to MOR ( P < .01). Among those with HNM, hazard was not proportional over time. Overall, subjects with MSN in the first 3.5 years of follow-up (75% of subjects) showed a 15% increased mortality when compared to MOHR ( P < .01); however, after 3.5 years, no difference in survival was noted ( P = .5). Conclusion Patients with HNM showed a higher mortality when compared to MOR. The risk of death of primary sites within the head and neck varies over time, showing a higher risk of mortality for scalp and neck during the first 3.5 years of follow-up. This increased risk was not evident after the 3.5-year threshold. Further research is needed to evaluate additional patient factors or differences in treatment approaches.

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“…Secondly, approximately 13% of the patients in the MSLT‐2 trial had head and neck primary melanomas; although univariate forest plot analysis suggested a trend in favor of CLND for patients who had a head and neck primary, it was not statistically significant. Although randomized data specific to head and neck melanoma are lacking regarding prediction of occult positive nodes (ie, detected by SLN biopsy) and especially of predicting non‐SLNs, non‐randomized and population level studies have supported that subsites of the scalp, neck, and face as well as tumor thickness, ulceration, and mitoses are associated with increased rates of occult nodal positivity while non‐SLN may be more likely in head and neck patients overall, when fewer SLNs are removed, with scalp primary location, and with increasing SLN tumor burden 29‐32 . Additional randomized or multi‐institutional studies would help inform if these often‐discussed aspects of risk for non‐SLN disease in head and neck melanoma are supported by more rigorous data.…”

Section: Surgical Management: Stage I‐iiimentioning

confidence: 99%

Updates in the evidence‐based management of cutaneous melanoma

2020

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Treatment of cutaneous melanoma is changing with significant developments over the past several years that promise to reshape the field of melanoma surgical oncology. Modifications to the staging system based on analysis of a large international dataset, the timing and extent of regional lymphadenectomy, the emergence of effective systemic therapies in the neoadjuvant and adjuvant setting, and the role of adjuvant radiation are all undergoing a data-driven evolution. Surgeon engagement in multidisciplinary decision making remains an essential component of contemporary management for patients across all stages of melanoma and demands specific involvement of head and neck surgical oncologists.

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Does the number of sentinel lymph nodes removed affect the false negative rate for head and neck melanoma?

Abstract: In HN melanoma cases in which multiple nodes are identified, removal of all SLNs will more adequately stage patients.

Cited by 15 publications

References 19 publications

Head & neck melanoma: A 22‐year experience of recurrence following sentinel lymph node biopsy

Head & neck melanoma: A 22‐year experience of recurrence following sentinel lymph node biopsy

The National Cancer Database: Survival Between Head and Neck Melanoma and Melanoma of Other Regions

Updates in the evidence‐based management of cutaneous melanoma

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