Prognostic implication of sentinel lymph node biopsy in cutaneous head and neck melanoma

Saltman, Benjamin; Ganly, Ian; Patel, Snehal G.; Coit, Daniel G.; Brady, Mary S.; Wong, Richard J.; Boyle, Jay O.; Singh, Bhuvanesh; Shaha, Ashok R.; Shah, Jatin P.; Kraus, Dennis H.

doi:10.1002/hed.21390

Cited by 66 publications

(79 citation statements)

References 14 publications

(22 reference statements)

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“…Patients who previously underwent a lymph node dissection were now selected to undergo a staging procedure associated with less morbidity. Sentinel lymph node biopsies in head and neck melanomas, however, have a false-negative rate of 30% given the complexity of the lymphatic drainage patterns [19], and subsequent management decisions in these cases are based on inaccurate staging results with the potential to negatively affect patient outcomes like disease-free survival, overall survival, and even brain metastasis-free survival. Changes in the standard of care for primary melanoma patients may therefore have confounded our evaluation of the head/neck site as a risk factor for melanoma brain metastasis development.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics at primary melanoma diagnosis as risk factors for brain metastasis

Qian¹,

Michelle

Fleming

et al. 2013

Melanoma Research

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Objective In order to better identify melanoma patients who are, at the time of primary melanoma diagnosis, at high risk of developing brain metastases, primary melanoma characteristics were examined as risk factors for brain metastasis development. Methods In a study of two patient cohorts, clinicopathological characteristics prospectively collected at primary cutaneous melanoma diagnosis for patients with/without brain metastasis were assessed in univariate and multivariate analyses using data from two prospectively-collected databases: Melanoma Cooperative Group (MCG) (1972–1982), and Interdisciplinary Melanoma Cooperative Group (IMCG) (2002–2009). Candidate risk factors were evaluated in association with time to brain metastasis via either the log-rank test or Cox proportional hazards regression analysis with/without considering competing risks. Results Out of 2341 total patients included in the study, 222 (9.5%) developed brain metastases (median follow-up: 98 months). The median time to brain metastases was 30.5 months, and the median survival time after brain metastases was 4 months. Increased hazard ratios (HR) for brain metastasis were found among thicker (logarithmic value in mm) (MCG – HR=1.97, P<0.0001; IMCG – HR=1.31, P=0.018), ulcerated (MCG –HR=1.93, P=0.01; IMCG – HR=3.14, P<0.0001), and advanced-stage (MCG – HR=2.08, P=0.008; IMCG – HR=2.56, P=0.0002) primary melanomas based on multivariate Cox regression analysis assuming the presence of competing risks. Conclusions Primary cutaneous melanoma thickness, ulceration, and stage were identified and validated as risk factors associated with time to melanoma brain metastasis.

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Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics at primary melanoma diagnosis as risk factors for brain metastasis

Qian¹,

Michelle

Fleming

et al. 2013

Melanoma Research

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“…Melanoma of the head and neck was observed to recur within the shortest time interval (9.5-19 months following SLNBx) [10,12]. Risk factors associated with recurrence of melanoma following a negative SLNBx included increased depth of the primary lesion, the presence of ulceration, advanced age at diagnosis and location of the primary lesion on the head and neck [13,14].…”

Section: Recurrence After Negative Slnbxmentioning

confidence: 97%

“…The radioactive dye's migration to the SLN is traced with imaging (lymphoscintigraphy) and detected with an intraoperative gamma probe; this technique results in a 95% identification rate, whereas the technique combining use of both dyes demonstrates a 99% localization rate. The probability of developing distant or local disease recurrence following a negative SLN is largely dependent of the tumor depth and biology and can range from 4 to 29% [9,10].…”

Section: Current Role Of Sentinel Lymph Node Biopsymentioning

confidence: 99%

Analysis of Melanoma Recurrence Following a Negative Sentinel Lymph Node Biopsy

Hodges

Jones

et al. 2015

Melanoma Manag.

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Little attention has been paid to the characteristics and outcomes of patients who experience distant, local or regional recurrence of melanoma following a negative sentinel lymph node biopsy. This article aims to review the published literature on the topic and presents some general summaries regarding this patient population. Patients who experience a disease recurrence following a negative sentinel lymph node biopsy have a worse overall survival compared with patients with a positive sentinel lymph node biopsy. The implications and possible explanations for these findings are discussed in order to both underscore the need for in-depth investigation of local, regional or distant melanoma recurrence among patients following a true negative sentinel lymph node biopsy, as well as increased efforts to minimize the rate of false negative sentinel lymph node biopsies.

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“…16 A higher false negative rate for SLNB in HNM also has been reported in several studies. 16-18 Therefore, the prognostic information from performing SLNB may not be as valuable for HNM as in other body sites, and the relative benefit to patients of undergoing the surgical procedure should be carefully evaluated.…”

Section: Introductionmentioning

confidence: 99%

Association of Sentinel Lymph Node Biopsy With Survival for Head and Neck Melanoma

Sperry

Charlton

Pagedar

2014

JAMA Otolaryngol Head Neck Surg

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Importance Sentinel lymph node biopsy (SLNB) provides prognostic information for melanoma; however, a survival benefit has not been demonstrated. Objective To assess the association of SLNB with survival for head and neck melanoma (HNM). Design Propensity score-matched retrospective cohort study using the Surveillance Epidemiology and End Results (SEER) database to compare patients with HNM initially treated with SLNB versus nodal observation. Setting United States population Patients Melanoma arising in head and neck subsites meeting current recommendations for SLNB, treated during the years 2004-2011 with either a) SLNB +/− neck dissection, or b) no SLNB or neck dissection. Intervention: SLNB +/− neck dissection Main Outcome Disease-specific survival (DSS) estimates based on the Kaplan-Meier method, and Cox proportional-hazards modeling to compare survival outcomes between matched-pair cohorts Results 7266 HNM patients meeting study criteria were identified from the SEER database. Matching of treatment cohorts was performed utilizing propensity scores modeled on 10 covariates known to be associated with SLNB treatment or melanoma survival. Cohorts were stratified by tumor thickness (thin: >0.75-1mm Breslow depth, intermediate: >1-4mm, and thick: >4mm) and exactly-matched within five age categories. In the intermediate-thickness cohort, 2808 HNM patients were matched and balanced by propensity score for SLNB treatment; the 5-year DSS estimate for those treated by SLNB was 89% vs. 88% for nodal observation (log-rank p=0.30). The hazard ratio for melanoma-specific death was 0.87 for those undergoing SLNB (95% CI 0.66-1.14, p=0.31). In each of the other cohorts analyzed, including the thin, thick, and overall cohorts, no significant difference in DSS was demonstrated. Conclusions This SEER cohort analysis demonstrates no significant association between SLNB and improved disease survival for patients with HNM.

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Prognostic implication of sentinel lymph node biopsy in cutaneous head and neck melanoma

Abstract: The SLN status is an important predictor of survival. The technique, performed in the head and neck is complex and associated with a high false-negative rate.

Cited by 66 publications

References 14 publications

Clinicopathological characteristics at primary melanoma diagnosis as risk factors for brain metastasis

Clinicopathological characteristics at primary melanoma diagnosis as risk factors for brain metastasis

Analysis of Melanoma Recurrence Following a Negative Sentinel Lymph Node Biopsy

Association of Sentinel Lymph Node Biopsy With Survival for Head and Neck Melanoma

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