Enhanced Sentinel Lymph Node Biopsy in Head and Neck Melanoma: Evaluating Accuracy and Oncologic Outcomes

Introduction: Sentinel lymph node biopsy (SLNB) is utilized in the upfront setting and plays a pivotal role in staging and guiding treatment in head and neck melanoma. At our institution, we performed a dual SLNB technique, using a gamma probe and indocyanine green (ICG), and described its accuracy in detecting SLNs and its impact on oncologic outcomes in head and neck melanoma.

Methods: An IRB-approved protocol was used for retrospectively collected data from patients with melanoma who underwent SLNB surgery from February 2011 to December 2021 at Cleveland Clinic. All patients underwent SLNB utilizing a combination of gamma probe and ICG. True-positive rate (TPR), false-negative rate (FNR), and adjusted false-negative rate (AFNR) were calculated. Follow-up, recurrence-free survival (RFS), and melanoma-specific survival (MSS) were estimated from the date of SLNB.

Results: In total, 334 melanoma patients were treated with surgical resection had simultaneous SLNB. Median age at diagnosis was 65.57 and the gender distribution was 26.9% female and 73.1% male. Mean tumor Breslow depth was 2.43 mm. Of 334 patients, 67 (20.1%) showcased SLND-positivity. Patients' stratification based on T stage: T1 (109), T2 (106), T3 (61), and T4 (31). True positive SLNs were 16 (13.4%), 20 (18.9%), 6 (26.2%), and 12 (38.7%), respectively, for each stage. Comparing our findings with the literature, we observed significant increases in TP percentages over expected values, specifically for T1, T2, T3, and T4 stages, with increases of 197.8%, 52.4%, 7.4%, and 10.6%, respectively. The FNR and AFNR were both 2.2% in contrast to the literature's range of 5% to 10%. RFS was 93% at 12 months and 91.7% at 18 months. MSS rates at 24, 36, and 60 months were 99%, 96.9%, and 92.82% respectively.

Conclusions: The utilization of the dual SLNB technique enhances the TPR and reduces the FNR in head and neck melanoma. The technique not only aids in identifying non-clinically detectable malignant lymph nodes but also highlights its role in improving survival among this population. Further study is needed to determine its effectiveness in improving disease control and survival.