Sentinel Lymph Node Biopsy for Cutaneous Head and Neck Melanomas

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Abstract
REGIONAL NODAL metastases occur infrequently in thin cutaneous melanomas (4 mm) are associated with a high incidence of distant metastases, and, therefore, ELND may not affect survival in this population. Active debate continues as to the clinical effect of ELND in patients with intermediate-thickness melanomas (1-4 mm thick). Even in this group, only approximately 15% of patients will have histologically demonstrable metastatic nodes, so that the remaining 85% undergoing routine ELND may be considered to have undergone an unnecessary procedure. Four randomized trials1-4 and 1 large, retrospective study5 of patients with intermediate-thickness melanomas have not demonstrated any improvement in survival after ELND. Against this background, the advantage of sentinel lymph node biopsy (SLNB) for cutaneous head and neck melanoma is the potential to avoid the morbidity of routine ELNDs while accurately and pathologically staging the regional nodes at risk for micrometastases. This has clear implications for patient prognosis and for their eligibility to participate in clinical trials of adjuvant therapy. The usefulness and reliability of SLNB has been well described in the literature since it was first reported in 1990.6 In contrast to other sites within the body, the head and neck region presents unique challenges in terms of the anatomy, the technique, and the interpretation of SLNB results. This study was undertaken to assess our experience with SLNB, with a special focus on these issues.