The Utility of Sentinel Lymph Node Biopsy in Head and Neck Melanoma in the Pediatric Population

Abstract

Intraoperative lymph node mapping and sentinel lymph node biopsy have proven beneficial techniques in staging adult patients with melanoma of the head and neck, where there is great variability in lymphatic drainage. This technique has also been applied to pediatric patients with truncal cutaneous melanomas in an effort to determine nodal status without the morbidity associated with complete lymph node dissection. Nevertheless, the utility of sentinel lymph node biopsy in head and neck melanoma in the pediatric population has not been established. The objective of the authors' study was to determine the clinical utility of intraoperative lymph node mapping and sentinel lymph node biopsy of head and neck melanoma in the pediatric population. The authors reviewed the records of seven pediatric patients with head and neck melanoma or borderline melanocytic proliferations of unknown biologic potential who underwent intraoperative lymph node mapping and sentinel lymph node biopsy between 1998 and 2001. All sentinel lymph node specimens were examined by a melanoma dermatopathologist for the presence of metastatic melanoma. The mean operative time for each case was 3 hours, 8 minutes (range, 2 hours, 15 minutes to 3 hours, 50 minutes). All seven pediatric patients who underwent extirpation of a primary head and neck melanoma and preoperative lymphoscintigraphy had unique and identifiable basins of drainage to regional nodal groups. Four of seven patients had at least one positive sentinel lymph node. Overall, five of 19 sentinel nodes (26 percent) resected had evidence of metastatic melanoma. Of the patients with positive sentinel lymph nodes, two of the primary lesions were diagnosed as melanoma while two were initially considered atypical melanocytic proliferations of uncertain biologic potential with melanoma in the differential diagnosis. Sentinel lymph nodes in pediatric patients with melanoma of the head and neck can be successfully mapped and biopsied, as in adult patients. In addition, this procedure can provide critical diagnostic information for those pediatric patients with diagnostically challenging, controversial, or borderline melanocytic lesions.

Use of sentinel lymph node biopsy for melanoma in children and adolescents

“…Overall, 25.6% of patients undergoing SLNB had LNM in our study, and this figure is similar to prior published data [5,6,33,37,41,42]. Though the incidence of LNM is Journal of Surgical Oncology known to be higher in children, children with LNM have a lower incidence of recurrence and improved disease-free survival compared to adults [5,32,43].…”

The role of sentinel lymph node biopsy for melanoma: Evidence assessment

“…12,13,[89][90][91][92][93][94][95] Radiopharmaceuticals at dosages used for SLNB carry negligible risk and are not contraindicated in pregnancy. Because of the risk of a rare but potentially catastrophic event of anaphylaxis to vital blue dye in patients who are pregnant, use of radiocolloid alone for SLNB in pregnancy is used at our institutions.…”

Auricular malignant melanoma of early childhood: the role of sentinel node biopsy

“…Its utilization in adult cases has become ubiquitous however its adaptation in pediatric melanoma is seldom reported [3,6]. Despite the complex lymphatic drainage in the head and neck, sentinel node biopsy has been proven to be an accurate and minimally invasive mean of nodal staging [5].…”

“…Sentinel node biopsy has become the gold standard of melanoma staging method in adults [4,5]. However, its utilization in pediatric melanoma is seldom reported and even more rare in the region of head and neck [3,6]. With a recent increase in the incidence of adolescent melanoma [7,8], the need for an widely accepted therapeutic protocol has also increased.…”