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A Prospective Study of Intraoperative Lymphatic Mapping for Head and Neck Cutaneous Melanoma
Susan A. Eicher, MD;
Gary L. Clayman, DDS, MD;
Jeffrey N. Myers, MD, PhD;
Ann M. Gillenwater, MD
Arch Otolaryngol Head Neck Surg. 2002;128:241-246.
Background Intraoperative lymphatic mapping and sentinel lymph node biopsy have
been used successfully to stage regional lymphatics for trunk and extremity
melanomas. However, the accuracy and applicability of these techniques in
the head and neck have not been determined conclusively.
Objective To report the results of a prospective trial of intraoperative lymphatic
mapping and sentinel lymph node identification in patients with head and neck
cutaneous melanoma.
Methods Using technetium Tc 99m–labeled sulfur colloid and isosulfan blue,
intraoperative lymphatic mapping and sentinel lymph node identification were
performed in 43 patients with melanomas of intermediate thickness. After the
sentinel lymph nodes were identified in situ, an elective dissection of levels
I through V or II through V was performed, based on the location of the primary
tumor. The parotid, postauricular, and suboccipital lymphatics were dissected
as clinically indicated. The sentinel lymph nodes were isolated ex vivo and
evaluated pathologically by serial sectioning, and the accuracy of the lymphatic
mapping was determined.
Results Intraoperative lymphatic mapping identified 155 sentinel lymph nodes
in 94 nodal basins, with a mean of 3.6 sentinel nodes and 2.2 basins per patient.
Sentinel nodes were located in the parotid gland in 19 patients (44%), necessitating
superficial parotidectomies, and they were distributed throughout nonadjacent
nodal basins in 18 patients (42%). Nine patients (21%) had metastatic disease
in 1 or more sentinel nodes, 3 of whom had metastatic disease in a nonsentinel
node. No patient who had negative sentinel nodes had a positive nonsentinel
node (false-negative incidence, 0).
Conclusions Although intraoperative lymphatic mapping accurately identifies sentinel
lymph nodes for head and neck cutaneous melanomas, the multiplicity of these
nodes, their widespread distribution, and their frequent location within the
parotid gland may preclude sentinel lymph node biopsy in many patients. Therefore,
we advocate selective lymphadenectomy of sentinel nodal basins, allowing histological
staging of the regional lymphatics with limited morbidity. However, further
study is necessary to define the true role of sentinel lymph node identification
for head and neck cutaneous melanoma.
From the Department of Head and Neck Surgery, The University of Texas
M.D. Anderson Cancer Center, Houston.
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