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Omission of Completion Lymph Node Dissection in Sentinel Node Biopsy Positive Head and Neck Cutaneous Melanoma Patients

  • Melanoma
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent studies evaluating patients with a positive sentinel lymph node biopsy (SLNB+) show no melanoma-specific survival difference between patients undergoing lymph node basin surveillance and completion lymph node dissection (CLND). This has been broadly applied, despite underrepresentation of head and neck (HN) cutaneous melanoma patients. We evaluated whether this was upheld in the HN melanoma cohort.

Methods

Patients with HN melanoma with a SLNB+ were selected from the National Cancer Database (NCDB) from 2012 to 2019. Overall survival (OS) of patients who underwent SLNB only versus SLNB + CLND were compared. Subgroup analyses were performed based on pathologic N (pN) and receipt of immunotherapy. Adjusted hazard ratio (aHR) and 95% confidence interval (CI) were calculated.

Results

Analysis of 634 patients with multivariable Cox regression showed no difference in OS in SLNB only versus SLNB + CLND cohorts (hazard ratio [HR] 1.13; 95% confidence interval [CI] 0.71–1.81; p = 0.610). Charlson–Deyo score (CDS) 1 versus 0 (HR 1.70; 95% CI 1.10–2.63; p = 0.016), pN2+ versus pN1 (HR 1.74; 95% CI 1.23–2.45; p = 0.002), and lymphovascular invasion (LVI) versus no (HR 2.07; 95% CI 1.34–3.19; p = 0.001) were associated with worse prognosis. Subgroup analysis by pN showed no OS benefit for CLND in either pN1 (HR 1.04; 95% CI 0.51–2.10; p = 0.922) or pN2+ (HR 1.31; 95% CI 0.67–2.57; p = 0.427) patients or in patients who received immunotherapy (HR 1.32; 95% CI 0.54–3.22; p = 0.549).

Conclusions

This study of SLNB + HN melanoma patients showed no OS difference in SLNB only versus SLNB + CLND. Further studies need to be performed to better define the role of CLND.

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Authors and Affiliations

  1. Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA

    Susan B. Kesmodel MD, Neha Goel MD, Daniel N. Weingrad MD & Jessica S. Crystal MD

  2. Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA

    Susan B. Kesmodel MD, Wei Zhao MD, MS, Tulay Koru-Sengul PhD, Neha Goel MD, Leonel Hernandez-Aya MD, Jose Lutzky MD, Lynn Feun MD & Jessica S. Crystal MD

  3. DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA

    Joshua P. Kronenfeld MD

  4. Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA

    Tulay Koru-Sengul PhD

  5. Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA

    Leonel Hernandez-Aya MD, Jose Lutzky MD & Lynn Feun MD

  6. Division of Surgical Oncology, Department of Surgery, West Virginia University, Morgantown, WV, USA

    Mary Garland-Kledzik MD

Authors
  1. Susan B. Kesmodel MD
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  2. Joshua P. Kronenfeld MD
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  3. Wei Zhao MD, MS
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  11. Jessica S. Crystal MD
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Corresponding author

Correspondence to Jessica S. Crystal MD.

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Disclosure

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC’s NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Kesmodel, S.B., Kronenfeld, J.P., Zhao, W. et al. Omission of Completion Lymph Node Dissection in Sentinel Node Biopsy Positive Head and Neck Cutaneous Melanoma Patients. Ann Surg Oncol 30, 7671–7685 (2023). https://doi.org/10.1245/s10434-023-14036-8

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