A Face Lift Approach for Sentinel Node Biopsy in Head and Neck Melanoma Patients

Abstract

Management of head and neck melanoma has changed dramatically with the use of sentinel node biopsy for staging. Nodal dissection may now be delayed or deferred based on the results of the sentinel node biopsy. The authors suggest using a face lift incision to access the nodal basins for sentinel node biopsy in head and neck melanoma. A face lift incision was used successfully for sentinel node biopsy in 21 patients. The diagnosis of melanoma, histologic subtype, and depth of penetration were established by biopsy with permanent sections. All patients underwent lymphoscintigraphy on the morning of their surgery. If the scan showed multiple nodes at various levels of the neck or parotid, the patient was selected for a face lift incision for biopsy. The study comprised 14 men and seven women between the ages of 26 and 82 years (mean age, 55 years). The sites of melanoma included the temple in six patients, cheek in five, neck in four, and ear and scalp in two patients each. The average Clark's level and Breslow depth were 3.67 and 1.76 mm, respectively. The average number of basins involved was 2.14; the average number of nodes was 3.33, with an average of 1.56 nodes per basin. Follow-up ranged from 2 to 53 months (average, 26 months). Only two patients had sentinel nodes that were positive for metastatic melanoma. One complication, a transient paresis of the right marginal mandibular nerve, was observed. Using a face lift incision for sentinel node biopsy in head and neck melanoma is a safe, reliable technique. It provides excellent access to multiple nodal basins, well-concealed incisions, wide exposure for delayed therapeutic nodal dissection, and local and regional flap options for reconstructing the excision site.