Regional Control of Head and Neck Melanoma with Selective Neck Dissection

Abstract

Objective: Historically, patients with cervical metastases from melanoma of the head and neck were treated with a modified radical or radical neck dissection. The purpose of our study was to evaluate the efficacy of therapeutic selective neck dissection (SND) in this high-risk population. Method: Retrospective, single-cohort study from a prospective institutional database. Patients underwent therapeutic SND for clinically node positive head and neck melanoma (n = 14) or pathologically node positive disease after sentinel lymph node biopsy (SLNB) (n = 27). Univariate and multivariate analyses were conducted. Primary end points were regional recurrence and regional recurrence free survival. Results: Forty-one patients underwent therapeutic SND from 2001 to 2010. The median number of positive nodes was 1 (range, 1-16 months). Twenty-six patients (63%) received adjuvant radiation and 23 patients (56%) received adjuvant immunotherapy or chemotherapy. The median follow-up time was 17 months (range, 1-116 months). Regional control was achieved in 29 patients (71%). Median regional recurrence-free survival was 21 months (range, 1-116 months). Advanced age was a significant predictor of regional recurrence ( P = .012) while tumor depth, extracapsular spread, number of nodes positive, prior SLNB, extent of neck dissection, adjuvant radiotherapy, and adjuvant immunotherapy were not significant. Conclusion: Therapeutic SND with frequent use of adjuvant radiation therapy is effective in achieving regional control of head and neck melanoma with cervical metastases. Older patients may be at increased risk of regional recurrence after SND for head and neck melanoma.