Completion Node Dissection in Patients with Sentinel Node–Positive Melanoma of the Head and Neck

Abstract

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.