Completion node dissection in patients with sentinel node-positive melanoma of the head and neck.
OBJECTIVE: Determine if completion lymph node dissection (CLND) is associated with improved survival in sentinel lymph node (SLN)-positive cutaneous melanoma of the head and neck (CMHN) patients. STUDY DESIGN: Retrospective analysis of large population database. SETTING: Surveillance, Epidemiology and End Results (SEER) database/multiple settings. SUBJECTS AND METHODS: Using the SEER database, the authors identified patients with SLN-positive CMHN. Clinicopathologic data and 5-year disease-specific survival (DSS) were examined for patients who underwent sentinel lymph node biopsy (SLNB) alone vs SLNB + CLND. RESULTS: Among 350 SLN-positive patients, 210 (60%) had SLNB + CLND, and 140 (40%) had SLNB only. Patients in the SLNB-only group were significantly older (median age 62 vs 53 years, P < .0001). The cohort as a whole did not significantly benefit from CLND; however, CLND was associated with improved DSS for a subgroup of patients age <60 years with nonulcerated tumors ≤ 2 mm thick (P = .03). Relative to SLNB alone, CLND did not improve survival for patients age ≥ 60 years or those with thicker (>2 mm) or ulcerated tumors. CONCLUSIONS: Compared with SLNB alone, CLND does not seem to be associated with improved survival for most patients with SLN-positive CMHN. CLND likely improves survival for patients age <60 years with thin (≤ 2 mm) nonulcerated tumors and when there is a low risk of identifying positive non-SLNs.
Smith, VA; Cunningham, JE; Lentsch, EJ
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