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Impact of Sentinel Node Status and Other Risk Factors on the Clinical Outcome of Head and Neck Melanoma Patients
Stanley P. L. Leong, MD;
Neil A. Accortt, PhD;
Richard Essner, MD;
Merrick Ross, MD;
Jeffrey E. Gershenwald, MD;
Barbara Pockaj, MD;
Harald J. Hoekstra, MD;
Carlos Garberoglio, MD;
Richard L. White, Jr, MD;
David Chu, MD;
Merrill Biel, MD;
Kim Charney, MD;
Harold Wanebo, MD;
Eli Avisar, MD;
John Vetto, MD;
Seng-Jaw Soong, PhD; for the Sentinel Lymph Node Working Group
Arch Otolaryngol Head Neck Surg. 2006;132:370-373.
Objective To determine the impact of sentinel lymph node (SLN) status and other risk factors on recurrence and overall survival in head and neck melanoma patients.
Design The SLN Working Group, based in San Francisco, Calif, with its 11 member centers, the John Wayne Cancer Institute, and The University of Texas M. D. Anderson Cancer Center pooled data on 629 primary head and neck melanoma patients who had selective sentinel lymphadenectomy. A total of 614 subjects were analyzable. All centers obtained internal review board approval and adhered to the Health Insurance Portability and Accountability Act of 1996 regulations. A Cox proportional hazards model was used to identify factors associated with overall and disease-free survival.
Setting Tertiary care medical centers.
Main Outcome Measure Clinical outcome of head and neck melanoma patients undergoing selective sentinel lymphadenectomy.
Results Overall, 10.1% (n = 62) of the subjects had at least 1 positive node. Subjects with positive SLN status had significantly thicker tumors (mean thickness, 2.8 vs 2.1 mm; P<.001), and were more likely to have ulcerated tumors (P = .004). During the median follow-up of 3.3 years, the overall mortality from head and neck melanoma was 10%, with more than 20% experiencing at least 1 recurrence. Multivariate analysis showed that tumor site was an independent predictor of mortality; location on the scalp had a more than 3-fold (P<.001) greater mortality than tumors on the face. Tumor thickness was also an independent predictor of overall survival, and SLN status was the most important predictor of disease-free survival in the multivariate model (P<.001). Tumors on the scalp had the highest rate of recurrence, while those on the neck had the lowest. Tumor ulceration was the significant predictor of time to recurrence or disease-free survival (P<.001).
Conclusion In this multicenter study, SLN status and other risk factors have an effect on recurrence and/or overall survival.
Author Affiliations: Department of Surgery, University of California, San Francisco (Dr Leong); Department of Biostatistics and Bioinformatics, University of Alabama at Birmingham (Drs Accortt and Soong); John Wayne Cancer Institute, Santa Monica, Calif (Dr Essner); The University of Texas M. D. Anderson Cancer Center, Houston (Drs Ross and Gershenwald); Department of Surgical Oncology, Mayo Clinic, Scottsdale, Ariz (Dr Pockaj); Department of Surgical Oncology, Groningen University Medical Center, Groningen, the Netherlands (Dr Hoekstra); Department of Surgery, Loma Linda University Medical Center, Loma Linda, Calif (Dr Garberoglio); Department of General Surgery, Carolinas Medical Center, Charlotte, NC (Dr White); Department of Surgical Oncology, City of Hope Medical Center, Duarte, Calif (Dr Chu); ENT Specialty Care of Minnesota, PA, Minneapolis (Dr Biel); Department of Surgery, St Joseph Hospital, Orange, Calif (Dr Charney); Department of Surgery, Roger Williams Medical Center, Providence, RI (Dr Wanebo); Department of Surgery, University of Miami Jackson Memorial Hospital, Miami, Fla (Dr Avisar); and Division of Surgical Oncology, Oregon Health and Sciences University, Portland (Dr Vetto).
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