Sentinel lymph node biopsy effective for head, neck melanoma
MedWire News: Sentinel lymph node biopsy (SLNB) is suitable for use in patients with head and neck melanoma, US study findings suggest.
"Despite concerns about the procedure for this population compared with truncal or extremity melanomas, SLNB is accurate, and its results are of prognostic importance for head and neck melanoma patients," remark Carol Bradford (University of Michigan Health System, Ann Arbor) and colleagues.
The researchers investigated the safety and accuracy of SLNB by analyzing the biopsy results of 353 head and neck melanoma patients.
The time to melanoma recurrence, sites of recurrence, and dates and causes of death were also collated for these patients.
Writing in the journal Cancer, Bradford and team report that a SLN was successfully identified in 352 (99.7%) of the 353 patients, and at least one of these nodes was positive in 69 (19.6%) patients.
In all, 68 (98.5%) patients with a positive SLNB underwent completion lymphadenectomy and 25% of these patients had one or more positive non-SLN identified from this procedure.
Among the 283 patients with a negative SLNB, 44 (15.5%) experienced recurrence of the melanoma.
Bradford and team report a 14.8% SLNB false-negative rate and a negative predictive value of 95.8% for a negative SLNB.
On multivariate analysis, the team found that a positive SLNB result was the strongest determinant of a poor patient outcome.
Indeed, patients with positive SLNB results had a 4.23-fold higher likelihood of experiencing disease recurrence over a median period of 35 months, compared with those with a negative SLNB.
The overall likelihood of survival over this time period was 3.33-fold higher among SLNB-negative than SLNB-positive patients.
Bradford and colleagues explain that although SLNB is routinely offered to patients with melanoma, the procedure is traditionally reserved for those with truncal or limbal melanoma only. This is because the intricate nerve and blood vessel network in the head and neck regions are often feared to pose a safety risk during a biopsy.
Contrary to this opinion, Bradford and colleagues found that no patients in the study group obtained permanent cranial nerve injuries from undergoing SLNB procedure.
"Overall, our findings support that SLNB should be performed in patients with head and neck melanoma for the same indications as patients with truncal or extremity melanoma with comparable feasibility, safety, accuracy, and prognostic value," conclude Bradford et al.
By Lauretta Ihonor