Role of the Head and Neck Surgeon in Sentinel Lymph Node Biopsy for Cutaneous Head and Neck Melanoma

Authors

  • Doris Lin MD,

    1. Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California
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  • Mohammed Kashani-Sabet MD,

    1. Melanoma Center, Department of Dermatology, University of California, San Francisco, California, U.S.A.
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  • Mark I. Singer MD

    Corresponding author
    1. Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, California
    • Dr. Mark I. Singer, Department of Otolaryngology—Head and Neck Surgery, University of California, San Francisco, 2380 Sutter Street, Box 1703, San Francisco, CA 94143–0342, U.S.A.
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  • Presented at the Annual Meeting of the Triological Society, Phoenix, AZ, April 30–May 3, 2004.

Abstract

Objective: To determine the reliability of sentinel lymph node biopsy (SLNB) in head and neck cutaneous melanomas to accurately stage nodal basins, describe techniques for safe SLNB in the neck and parotid regions, and discuss treatments.

Study Design: Retrospective chart review with follow-up mean of 11 months.

Methods: The charts of 80 patients treated for head and neck cutaneous malignancies from January 2001 through June 2003 were reviewed for presentation, treatment, and outcome.

Results: All patients received lymphoscintigraphy and SLNB for melanoma with Breslow thickness greater than 1 mm. Accurate preoperative lymphoscintigraphy and blue dye injection along with facial nerve monitoring when indicated correlated with safe SLNB. Eleven (14%) patients required completion surgery after positive SLNB and underwent evaluation for adjuvant therapies. There were three cases with complications: two postoperative hematomas and one seroma.

Conclusions: Safe and reliable SLNB depends on the knowledge of the anatomy in the head and neck region, reliability of preoperative lymph node mapping with lymphoscintigraphy, and possible additions of blue dye injection and facial nerve monitoring. Complete surgical treatment of positive SLNB cases along with adjuvant therapies potentially improves control of these cutaneous malignancies with manageable morbidity.

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