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Sentinel Node Biopsy Safe, Effective in Head and Neck Melanomas


Sentinel lymph node biopsy (SLNB) is a common technique for determining whether melanoma has spread. There has been much debate around the accuracy and prognostic implications of SLNB for cutaneous melanoma arising in the head and neck.

A new study from the University of Michigan Comprehensive Cancer Center has found the technique can be used safely and effectively even in melanoma from the head and neck area.

SLNB involves injecting a special dye to identify the first node where cancer would likely spread. If that node is clean, patients can avoid further, often debilitating, surgery to remove multiple lymph nodes. If that node shows cancer, patients know they need the more extensive surgery or further treatment with radiation, chemotherapy or a clinical trial.

SLND should be offered to all patients with a clinically negative nodal basin and a primary melanoma greater than 1 mm in depth.

In the current study, which appears online in Cancer, Carol Bradford, M.D., professor and chair of otolaryngology at the U-M Medical School, and colleagues looked at 353 head and neck melanoma patients who had received sentinel lymph node biopsy over a 10-year period.

After reviewing patients' records, the researchers found that the sentinel lymph node could be identified in all but one patient (352/353 patients, 99.7%), and no patients sustained permanent nerve injuries during the procedure.

Almost 20% of the patients had at least one sentinel node positive for cancer (68/353, 19.6%). Of these 68 patients who were referred for a complete lymphadenectomy dissection, 17 (25%) had at least 1 additional positive nonsentinel lymph node.

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Among the remaining 283 patients with negative sentinel nodes, 12 patients recurred in the region where the sentinel lymph node was identified. This suggests that the test yielded 12 false-negative results, which means a negative test was incorrect 4% of the time. This rate is similar when sentinel lymph node biopsy is used for melanomas in other parts of the body.

"Sentinel lymph node biopsy is a safe and effective way to determine the status of the regional nodal basin for melanomas affecting the head and neck region. Furthermore, our study showed that it can be done accurately for these patients," says study author Carol Bradford, M.D., professor and chair of otolaryngology at the U-M Medical School.

The researchers also found that sentinel lymph node biopsy was the biggest predictor of how well a patient would do after surgery, including overall survival as well as recurrence-free survival.

"This procedure should be offered in patients with head and neck melanomas the same as patients with melanomas in other parts of the body. Not only is sentinel lymph node biopsy feasible and safe in these patients, but it helps determine the best course of treatment to offer patients the best hope of survival," Bradford says.

The authors stress the need for patients with head and neck melanoma to seek out a specialist in head and neck cancer surgery and sentinel lymph node biopsy.

The above story is reprinted (with editorial adaptations by Ramona Bates, MD) from materials provided by University of Michigan Health System.

Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma; Audrey B. Erman, Ryan M. Collar, Kent A. Griffith, Lori Lowe, Michael S. Sabel, Christopher K. Bichakjian, Sandra L. Wong, Scott A. McLean, Riley S. Rees, Timothy M. Johnson, Carol R. Bradford; Cancer, Published online on Jul 19, 2011; DOI: 10.1002/cncr.26288

Sentinel Lymph Node Biopsy in Patients With Melanoma; Author: Richard D Keidan, MD; Chief Editor: Arlen D Meyers, MD, MBA; MedScape, May 26, 2011