Patterns of drainage and recurrence following sentinel lymph node biopsy for cutaneous melanoma of the head and neck

Objectives: To analyze lymphatic drainage patterns and recurrence patterns in patients undergoing sentinel lymph node biopsy (SLNB) for cutaneous he-ad and neck melanoma. Design: Retrospective review of a consecutive series with a mean follow-up of 35 months. Setting: Tertiary cancer care center. Patients: Fifty-one patients with clinically node-negative cutaneous melanoma of the head and neck region staged by means of SLNB. Interventions: Sentinel lymph nodes (SLNs) were identified using preoperative lymphatic mapping along with intraoperative gamma probe evaluation and isosulfan blue dye injection. Patients with a positive SLNB finding by hematoxylin-eosin or immunohistochemical evaluation underwent completion lymphadenectomy of the affected lymphatic basin and were considered for further adjuvant treatment. Patients with a negative SLNB finding were observed clinically. Main Outcome Measures: Location characteristics of SLNs, incidence of positive SLNs, same-basin recurrence, and disease-free survival. Results: The mean number of SLNs per patients was 2.75. The extent of SLNB included removal of I node (n = 11), multiple nodes from I basin (n= 18), 1 node in multiple basins (n = 7), and multiple nodes in multiple basins (n = 15). Drainage to unexpected basins was found in 13 of 51 patients. Parotid region drainage was identified in 18 patients. There were no same-basin recurrences in patients with a negative SLNB finding. Thirty-six-month disease-free survival was 88.9% for patients with a negative SLN and 72.9% for patients with a positive SLN (P =. 17). Conclusions: The number and location of SLNs is variable and difficult to predict for head and neck cutaneous melanoma. Preoperative lymphoscintigraphy is an important planning instrument to guide complete removal of all SLNs. Based on 3-year follow-up, this procedure can be expected to provide low same-basin recurrence rates for patients with a negative SLN.