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Purpose: The head and neck (HN) has a rich lymphatic drainage and complex anatomy that complicate sentinel lymph node (SLN) biopsy for melanoma. The incidence of regional recurrence after negative SLN biopsy has been shown to be higher than other sites. Compounding factors in this scenario are analyzed to determine their impact both on SLN status and survival.
Methods: A retrospective review of a prospective database of 355 patients who underwent SLN biopsy for HN melanoma from 1994-2009 was performed. Head and neck primary sites were defined as scalp, face, neck, ear, and eyelid. Lymphatic nodal basins were defined as anterior and posterior neck and parotid gland. A false negative (FN) SLN biopsy was defined as regional recurrence in a previously mapped nodal basin in the absence of local or in transit recurrence.
Results: SLN biopsy was successful in 337 patients (94.9%). Forty-eight patients (14.2%) were SLN+. FN SLN biopsy occurred in 14 patients (4.8%). The mean follow-up was 38.3 months. Comparison between the three groups is depicted in Table I. The FN SLN rates by site were: ear 2.0%, eyelid 0%, face 5.1%, neck 6.5%, and scalp 5.3% (NS). Kaplan Meier melanoma specific survival of the SLN+ and the FN SLN groups in depicted in Figure 1. The mean melanoma specific survival was: SLN+ 2167 days and FN SLN 2219 days (p=0.33)
Table I

Factor	FN SLN (%)	SLN- (%)	SLN+	P value
Basins				NS
• 1	7 (50%)	142 (51.6%)	27 (56.3%)
• > 1	7 (50%)	133 (48.4%)	21 (43.7%)
Thickness (mean)	2.84	2.47	3.59	P=0.003
Ulceration	3 (21.4%)	75 (27.3%)	17 (35.4%)	NS

Conclusions: FN SLN biopsy in HN melanoma is independent of primary site and lymphatic nodal drainage. Patients with a FN SLN biopsy for HN melanoma have thinner primary lesions than patients with SLN+ biopsies but do not appear to have a survival difference.
Figure 1 Kaplan Meier Melanoma Specific Survival