Neck Nodes In Patients Research Articles

Pre-Operative Calcitonin and CEA Values May Predict the Extent of Metastases to the Lateral Neck Lymph Nodes in Patients with Medullary Thyroid Cancer.

Background: In medullary thyroid cancer (MTC), lymph node metastases are often present at diagnosis and the extent of surgery is usually based upon pre-operative calcitonin and CEA levels as well as ultrasound findings. The aim of this study was to evaluate the role of pre-operative calcitonin and CEA levels as predictive markers of the burden of lymph node metastases at diagnosis. Methods: we conducted a retrospective study analyzing 87 MTC patients. Results: The median levels of calcitonin and CEA were 88.4 pg/mL and 7.0 ng/mL, respectively, in patients with no lymph nodes metastases; 108.0 pg/mL and 9.6 ng/mL, respectively, in patients with metastases to 1-5 lymph nodes; 520.5 pg/mL and 43.2 ng/mL, respectively, in patients with metastases to >5 lymph nodes. There were no significant differences in pre-operative calcitonin and CEA values between N0 and N1a patients, whereas they were significantly higher in N1b patients. Pre-operative cut-off levels distinguishing N0/N1a from N1b patients were 90 pg/mL for calcitonin (sensitivity 100%, specificity 59.3%, AUC = 0.82) and 17 ng/mL for CEA (sensitivity 100%, specificity 75%, AUC = 0.89). Conclusions: in patients with MTC, pre-operative serum calcitonin and CEA levels may drive the decision-making process to better define the extent of surgery.

Cervical lymph node metastasis of bladder cancer: a case report and review of literature

Objective To report an extremely rare case of bladder cancer patient with cervical lymph nodes, abdominal lymph nodes, and bone metastases at the same time. Methods and results The case was investigated by follow-up and immunohistochemistry was used in the pathological part. Result The patient was diagnosed with bladder cancer (high-grade urothelial metastatic epithelial cell carcinoma) by pathology and immunohistochemistry after transurethral resection of bladder tumor (TURBT) and metastatic bladder cancer by pathology and immunohistochemistry after cervical lymph node aspiration due to neck lymph node enlargement 1 year later, and a CT of the chest and abdomen suggested that the patient also had abdominal lymph node and bone metastases.At the 2.5-year regular chemotherapy follow-up, the patient showed that the abdominal lymph node metastasis disappeared, the cervical lymph node fusion shrank, and the bone metastasis still existed. Conclusion 1. Regular postoperative review is particularly important; 2.For patients with UCB who undergo TURBT, a effective regular perfusion program should be performed throughout the postoperative period; 3. For patients with postoperative metastatic symptoms of UCB, Complex treatment has a positive effect on patient prognosis; 4.The presence of enlarged head and neck lymph nodes in patients with bladder cancer should also be considered as metastatic of UCB.

N-Cadherin Expression with Metastasis of Neck Lymph Nodes in Patients with Nasopharyngeal Carcinoma.

Lymph node (LN) metastases were one characteristic of negative progress of NPC patient despite its advanced therapeutic approaches. One mechanism for the occurrence of epithelial to mesenchymal transition (EMT)-mediated metastases is by increasing N-cadherin expression. The purpose of this research is to determine investigating N-cadherin expression against metastatic LN in NPC cases. Samples were taken by unproportionate stratified random sampling. N-cadherin expression was examined using immunohistochemistry methods. N-cadherin expression was assessed visually by binocular light microscopy. We analyzed these data using Mann-Whitney U-test to examine N-cadherin expression and lymph node metastases. A strong expression was found in N3 group by 63.6%; 27.3% in the N2 group and 9.1% in the N1 group. In patients with NPC N0 or without lymph node metastases, N-cadherin expression is 0%. The expression of N-cadherin is indeed an indicator of the occurrence of lymph node metastases in NPC with a statistically significant analysis of p = 0.026 (p < 0.05). There were correlations between N-cadherin expression and lymph node metastasis on NPC patients.

Neck Lymph Node Recurrence in HNC Patients Might Be Predicted before Radiotherapy Using Radiomics Extracted from CT Images and XGBoost Algorithm.

The five-year overall survival rate of patients without neck lymph node recurrence is over 50% higher than those with lymph node metastasis. This study aims to investigate the prognostic impact of computed tomogram (CT)-based radiomics on the outcome of metastatic neck lymph nodes in patients with head and neck cancer (HNC) receiving definitive radiotherapy or chemoradiotherapy for organ preservation. The pretreatment 18F-FDG PET/CT of 79 HNC patients was retrospectively analyzed with radiomics extractors. The imbalanced data was processed using two techniques: over-sampling and under-sampling, after which the prediction model was established with a machine learning model using the XGBoost algorithm. The imbalanced dataset strategies slightly decreased the specificity but greatly improved the sensitivity. To have a higher chance of predicting neck cancer recurrence, however, clinical data combined with CT-based radiomics provides the best prediction effect. The original dataset performed was as follows: accuracy = 0.76 ± 0.07, sensitivity = 0.44 ± 0.22, specificity = 0.88 ± 0.06. After we used the over-sampling technique, the accuracy, sensitivity, and specificity values were 0.80 ± 0.05, 0.67 ± 0.11, and 0.84 ± 0.05, respectively. Furthermore, after using the under-sampling technique, the accuracy, sensitivity, and specificity values were 0.71 ± 0.09, 0.73 ± 0.13, and 0.70 ± 0.13, respectively. The outcome of metastatic neck lymph nodes in patients with HNC receiving radiotherapy for organ preservation can be predicted based on the results of machine learning. This way, patients can be treated alternatively. A further external validation study is required to verify our findings.

Post-Treatment Neck Dissection of Tonsillar and Base of Tongue Squamous Cell Carcinoma in the Era of PET-CT, HPV, and p16.

Human-papillomavirus (HPV)-positive tonsillar and base of tongue carcinomas (TSCC/BOTSCC) are rising in incidence and treatments with radiotherapy, chemoradiotherapy (RT/CRT), and neck dissections (NDs) have several side effects. Therefore, an improved selection of patients needing salvage NDs would be beneficial. We examined the prevalence and localisations of viable tumour cells in neck lymph nodes in patients post-RT/CRT, identified by fluorodeoxyglucose positron-emission tomography with computer-tomography (FDG PET-CT), with a focus on HPV-associated tumours. Patients with 217 TSCC/BOTSCC with tumours assessed for HPV-DNA and p16INK4a undergoing FDG PET-CT 12 weeks after treatment and/or an ND were included. The FDG PET-CT data were compared with the findings in the pathology report after the ND. In total, 36/217 (17%) patients were selected for an ND due to positive findings in post-treatment FDG PET-CT. Of these, 35/36 were HPV-associated, 10/36 (28%) had viable tumour cells in the pathology reports of the neck specimen, and 8/10 (80%) were consistent with the FDG PET-CT findings, while 2/36 (5%) were missed by FDG PET-CT. We conclude that FDG PET-CT 12 weeks after RT/CRT is useful, but not completely reliable for finding all the metastases of HPV-associated TSCC/BOTSCC. Nonetheless, our data indicate that an ND could be more selectively guided by FDG PET-CT.

Management of suspicious neck lymph nodes in patients with differentiated thyroid carcinoma

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

CYTOLOGICAL EVALUATION OF NECK LYMPH NODES FOR METASTATIC DISEASE

Background: Fine needle aspiration cytology (FNAC) is a simple, rapid and cost effective procedure with minimal complications for evaluating enlarged neck nodes, but also gives clue. Neck lymph nodes are a common site of metastasis for various carcinomas, usually from the upper aerodigestive tract and salivary gland or carcinoma of unknown primary. Objectives: To study different cytomorphological patterns of metastatic neck nodes. To evaluate the diagnostic utility of FNAC in diagnosis of metastatic lesions of lymph node. Methods: It is a one year prospective study comprised of all aspirates 139 lymphnodes of 968 patients. FNACs conducted in the Department of Pathology, Vydehi Institute of Medical Sciences, Bangalore, between January 2019 to December 2019. A total of 70 out of 139 peripheral neck nodes in patients diagnosed with metastatic neck lymph node on FNAC were included in the study. Results: Out of 70 cases included in our study, metastasis to the neck lymph nodes were most common in the age group 51 to 60 years (38.6%) followed by 61 to 70 years (28.6%). Male preponderance was noted with male to female ratio of 1.7:1. On cytological examination, squamous cell carcinoma was found to be the most common tumor metastasizing to the neck nodes, accounting for 37 (52.9%) cases followed by each 10 (14.3%) cases each of undifferentiated carcinoma and thyroid carcinoma, 9 (12.9%) cases of adenocarcinoma, 3 (4.3%) cases of parotid gland carcinoma and 1 (1.4%) case of germ cell tumor of testis. Conclusion: FNAC is an early and reliable tool for the diagnosis of metastatic neck nodes. Any enlarged neck node should be investigated to rule out metastasis.

Clinical, ultrasound and histopathological correlation of clinically N0 neck nodes in patients with cancers of the pharynx and larynx.

Background: The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymphadenopathy (N0) remains controversial. Neck palpation, as the method used in tumor, node, metastasis (TNM) staging, has limitations and can provide false negative results in some cases. Lymph node metastases are associated with a reduced survival rate but at the same time, neck dissection for the patient with N0 neck is not without risks or complications. Objectives: In prospective study, we compared palpation, ultrasonography (US) examination of the neck and histopathological examination in patients with cancers of the pharynx and larynx. Patients, Materials and Methods: Forty-six patients with cancers of the pharynx and larynx that presented with a N0 neck were prospectively analyzed. They were divided in two groups: 23 patients operated with an external approach including the control of the lymph node areas, and a second group of 23 patients operated using endoscopy and carbon dioxide (CO2) laser, no neck dissection – “watchful waiting policy”. All patients have had a flexible endoscopy of the pharynx and larynx, US of the neck and all received surgical treatment for their primary tumor. Imaging was performed in selected cases. All the removed lymph nodes were sent for histopathology. US was also used as a follow-up method. The US features of the examined lymph nodes were: diameters [longitudinal (L) and transverse (T)]; the ratio of the two diameters (L/T); shape; lymph node area; central hypodensity; regular/irregular margins; aspect (homogeneous or not). Results: US has detected 25 lymph nodes in the open surgery group and intraoperatively, we excised 31 (sensitivity of 80.6%). Ten lymph nodes showed metastases, with 100% accuracy of US, which have been confirmed both pathologically and immunohistochemically. US in the second group – patients treated with CO2 laser – detected at four patients 10 cervical lymph nodes that did not presented any malignant features. At recurrence alone, the US confirmed 100% presence of nodes metastases. Conclusions: US was superior to palpation and this method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis (N0).

A Comparison of 18F-FDG-PET/MRI and 18F-FDG-PET/CT in the Cancer Staging of Locoregional Lymph Nodes.

The aim of the study was to evaluate the yields of 2-deoxy-2-[18F]-fluoro-D-glucose positron-emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) and 18F-FDG-PET/computed tomography (CT) for the detection of metastatic involvement of locoregional neck nodes in patients with head and neck malignancy. A total of 90 patients (66 men and 24 women) met the inclusion criteria. Preoperative staging was performed: 53 examinations using PET/CT and 37 using PET/MRI. For PET/MRI, the study demonstrated a sensitivity of 89%, specificity of 64%, positive predictive value of 85%, and negative predictive value of 70%; PET/CT had a sensitivity of 95%, specificity 47%, positive predictive value of 82%, and negative predictive value of 78%. Both methods have a high yield in N-clinical staging with statistically insignificant differences. We assume PET/MRI to be the first-choice method in organ-targeted examinations, for pediatric patients and repeat examinations. In cases of MRI contraindication, PET/CT can be used with no impact on the quality of care.

A prospective analysis of prevalence of metastasis in levels IIB and V neck nodes in patients with operable oral squamous cell carcinoma

ObjectivesThe present study was designed to know and analyze the prevalence of pathological involvement of level IIB and V neck nodes in operable oral cavity squamous cell carcinomas. Materials and methodsAll treatment naïve, willing biopsy proven patients of age group 18–70 years with oral cavity squamous cell carcinomas undergoing surgery from May 2015 to December 2016 in a single tertiary care Institute were prospectively analyzed for level IIb and V involvement. ResultsA total of 199 patients met the selection criteria of the study. Most common site was buccal mucosa, majority were cT2 lesions and 90% underwent Modified neck dissection. 63% of patients had pN0 disease. The rate of involvement of level II b and V nodes was 3% and was associated with higher T size, disease burden in proximal basin and lymphovascular invasion. There was no skip metastasis to level IV. Only one patient had skip metastasis to levels V and IIB each. ConclusionTo conclude our data strongly supports omission of level IIb and level V nodal dissection routinely in patients with cT1 and T2 buccal cancers. However, a randomized controlled study to evaluate the morbidity as well as recurrence pattern between the selective and super-selective approach is warranted.

A Clinical, Radiological, and Histopathological Correlation of Neck Nodes in Patients Undergoing Neck Dissection.

Objectives:Management of neck metastases in terms of diagnosis and treatment has always been a controversial issue in patients of head and neck malignancy. The main area of debate in case of diagnosis lies with the fact that whether we should rely on ultrasound, as a diagnostic modality for diagnosing micrometastases in the neck in head and neck malignancy patients? The second controversial issue is the management of N0 neck, whether to be radical or conservative?Materials and Methods:This study was conducted on 70 diagnosed patients of head and neck carcinoma who were planned for resection of the primary. An appropriate neck dissection was performed in all the patients, and their clinical, ultrasonography, and postoperative histopathological neck findings were correlated.Results:In our center, the most common site of the primary tumor was oral cavity with most involving buccal mucosa. As expected, T4 lesions were commonly associated with nodal metastasis (71%). The sensitivity of clinical examination and ultrasound was 80% and 93.3%, respectively, and specificity of clinical examination and ultrasound was 57% and 27.2%, respectively. Histopathologically positive but clinically nonpalpable metastases in the study group were more frequent in levels Ib, II, and III, respectively.Conclusion:We concluded that ultrasonography being a low cost and a highly sensitive investigation can act in tandem with clinical examination for diagnosing the neck for metastases preoperatively in head and neck malignancy patients. However, due to its low specificity, we cannot completely rely on it, hence doing a neck dissection in selective form, will definitely improve the clinical course of the disease in N0 necks.

Ultrasound-Guided Needle Biopsy of Neck Lymph Nodes in Patients With Suspected Lung Cancer: Are the Specimens Sufficient for Complete Pathologic Evaluation to Guide Patient Management?

The purpose of this study is to determine the ability of ultrasound guided needle biopsy of a neck lymph node to provide adequate tissue for complete pathologic evaluation of suspected metastatic lung cancer, including molecular testing for epidermal growth factor receptor gene mutations by pyrosequencing and anaplastic lymphoma kinase gene rearrangement by fluorescence in situ hybridization. Institutional review board approval was obtained and the requirement for informed consent was waived. All ultrasound guided neck biopsies performed July 1, 2011, to June 30, 2015, were retrospectively reviewed, and all biopsies performed for suspected lung cancer metastatic to supraclavicular and cervical lymph nodes were included. Forty patients with suspected lung cancer underwent ultrasound-guided needle biopsy of an abnormal appearing neck lymph node identified on preprocedure computed tomography or positron emission tomography/computed tomography. Thirty-seven patients were subsequently diagnosed with lung cancer and 3 were diagnosed with lymphoma. A definitive pathologic diagnosis was rendered in 95% of neck node biopsies (38/40; 95% confidence interval, 84%-99%). Of the 36 specimens diagnostic for lung cancer, 16 were considered for further molecular testing and the specimen was adequate for molecular testing in 15 (94%; 73%-100%) cases. Therefore, the neck node biopsy specimens were adequate for complete pathologic workup in 93% (37/40; 81%-98%). No complications related to the biopsies were observed. In patients presenting with suspected lung cancer and suspicious neck lymph nodes, ultrasound-guided needle biopsy frequently provides adequate tissue for complete pathologic evaluation and eliminates the need for more invasive procedures.

Surgical approach to level VI in papillary thyroid carcinoma: an overview.

One of the most controversial issues in the treatment of thyroid cancer is the management of the central neck nodes in patients with papillary thyroid carcinoma (PTC). Lymph node involvement is common in patients with PTC and it may negatively affect recurrence rate and, probably, survival. Although therapeutic compartment-oriented central neck dissection is the standard treatment for patients with clinical nodal involvement (cN1) PTC, the role and the extension for elective or prophylactic central neck dissection (PCND) in patients with clinically node negative (cN0) neoplasms remains controversial. In recent years, in order to decrease the risk of postoperative complications related to PCND, unilateral central neck dissection has emerged as an alternative approach to bilateral central neck dissection.

52 Ultrasound guided fine needle aspiration (FNA) of supraclavicular neck nodes in patients with suspected lung cancer – a retrospective review of practice in North Devon district hospital

52 Ultrasound guided fine needle aspiration (FNA) of supraclavicular neck nodes in patients with suspected lung cancer – a retrospective review of practice in North Devon district hospital

The Predictive Value of Ultrasound Guided Fine Needle Aspiration in the Initial Staging of Neck Lymph Nodes in Patients with Papillary Thyroid Carcinoma

The Predictive Value of Ultrasound Guided Fine Needle Aspiration in the Initial Staging of Neck Lymph Nodes in Patients with Papillary Thyroid Carcinoma

Comparison of fine-needle aspiration cytology, ultrasound and thyroglobulin examination for the differential diagnosis of enlarged neck lymph nodes in patients with differentiated thyroid cancer after radioactive iodine remnant ablation

Objective To compare the value of fine-needle aspiration cytology (FNAC),Tg,TgAb and ultrasonography (US) for the differential diagnosis of lymph node metastasis in patients with DTC after operation and radioactive iodine remnant ablation.Methods A total of 61 DTC patients with enlarged lymph nodes detected by US or physical examination after operation and radioactive iodine remnant ablation were included.FNAC was performed on the lymph nodes under US guidance within one week and the results were compared with those of Tg,TgAb and US.Final results were confirmed by comprehensive FNAC,posttreatment whole,body scan (Rx-WBS) and clinical follow-up.x2 test and Fisher's exact test were performed.Resuits Fifty-eight DTC patients had successful FNAC results,and 40 patients were confirmed as malignant and 18 as benign after overall assessment.FNAC identified 39 malignant and 19 benign cases.The coincidence rates of FNAC with postoperative pathological diagnosis and Rx-WBS for malignant cases were 100％ (20/20) and 78.9％ (15/19),respectively.For the benign cases,the coincidence rates of FNAC with clinical follow-up and Rx-WBS were 93.3％ (14/15)and 4/4,respectively.The sensitivity,specificity and accuracy were 97.5％(39/40),100％(18/18) and 98.3％(57/58) for FNAC; 87.5％(35/40),55.6％(10/18) and 77.6％(45/58) for US; 92.5％(37/40),72.2％(13/18) and 86.2％(50/58) for Tg combined with TgAb (Tg/TgAb).The accuracy of FNAC was higher than that of US and Tg/TgAb(x2 =4.336,11.697,both P＜0.05),while US and Tg/TgAb showed no significant difference (x2 =1.450,P＞0.05).Tg/TgAb and US results were consistent in 39 cases with a diagnostic accuracy of 97.4％ (38/39) verified by FNAC,while the other 19 cases with inconsistent Tg/TgAb and US results were verified as malignant in 4 cases and benign in 15 cases.Conclusions FNAC is superior to US and Tg/TgAb in the evaluation of lymph node metastasis in DTC patients after operation and radioactive iodine remnant ablation.FNAC should be recommended particularly when Tg/TgAb and US had inconsistent results. Key words: Thyroid neoplasms; Lymph nodes; Biopsy, fine-needle; Ultrasonography; Thyroglobulin

Patterns of lymph node metastasis and their influence on outcomes in patients with submandibular gland carcinoma

Little is known about lymph node metastasis and the extent of neck dissection (ND) in patients with submandibular gland (SMG) carcinoma. We therefore evaluated the metastatic topography of neck lymph nodes in patients with SMG carcinoma and the influence of metastases on tumor recurrence and patient survival. The pattern of lymph node spread was analyzed in 64 patients with SMG carcinoma treated from January 1994 to January 2009. Disease-free survival (DFS), overall survival (OS), and distant metastasis-free survival (DMFS) were calculated, and the clinicopathological factors associated with each were analyzed. Positive pathological lymph nodes were detected in 31 (48.4%) patients and was found to correlate significantly with histologic grade (P<0.001) on univariate analysis. Eight patients (19.5%) had occult cervical metastases. The 5-year DFS, OS, and DMFS rates were 46.8, 56.2, and 58.5%, respectively, and 23 patients (35.9%) experienced systemic failure. Multivariate analyses revealed that T-classification (P=0.043) and N-classification (P=0.006) were significantly independent predictors of DFS, whereas only N-classification (P=0.049) was significantly associated with DMFS. Elective ND should be recommended for preoperatively suspected high-grade malignancy in SMG carcinoma. Patients with nodal metastasis should receive more effective therapy to hinder recurrence and distant metastasis.

Pathologic Occult Neck Disease in Patients With Metastatic Cutaneous Squamous Cell Carcinoma to the Parotid

The aim of this study was to document the rate of pathologic neck disease in patients presenting with metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid gland following parotidectomy and neck dissection in the clinically and radiologic negative neck. Case series with chart review. Tertiary referral center. The study involved a retrospective chart review from 1999 to 2008 of patients presenting with metastatic CSCC to the parotid at the Princess Alexandra Hospital, Brisbane, Australia. Eighty-one patients with metastatic parotid disease were identified. A total of 51 (63%) patients had no clinical or radiological evidence of cervical nodal disease. Forty-five patients (88%) were male, median age was 69 (range, 42-91) years, and the median follow-up was 16 (interquartile range, 9-44) months. Thirty-four of these patients underwent a parotidectomy and neck dissection with/without postoperative radiotherapy (RT). Occult pathological cervical nodal disease was found in 5 (14.7%) patients. Of those who received a neck dissection, 3 patients relapsed in the parotid, 1 in the neck alone, and 1 distantly. This series has shown that the rate of pathologically involved neck nodes in patients with metastatic CSCC to the parotid in the clinically node negative neck is low. Given many of these patients warrant postoperative RT to the parotid bed, an elective neck dissection may not be warranted as the parotid and neck may be treated in continuity with RT.

Role of ultrasound in detection of metastatic neck nodes in patients with oral cancer

Head and neck cancer is one of the most physically and emotionally devastating cancers and often leaves the patient disabled and disfigured. The presence of cervical metastasis is one of the factors that influence the outcome of the patients. Cervical lymph node metastasis plays an essential role in the treatment and prognosis of head and neck cancer patients. The assessment of the cervical lymph node status still remains an unsolved problem. We conducted a study to compare the diagnostic accuracy of clinical palpation and ultrasonogram (USG) in the detection of metastatic cervical nodes from oral squamous cell carcinoma patients. Ten patients (age range, 45-63 years; mean age, 54 years) with squamous cell carcinoma in the head and neck region underwent clinical palpation and USG. The results of each modality were analyzed for sensitivity, specificity, positi ve predictive value, negative predictive value and accuracy. Pathologic analysis of the surgical resection served as the reference standard. USG yielded a sensitivity, specificity, positive, negative predictive value and accuracy as 85.7%, 90%, 92.3%, 81.8% and 87.5% whereas clinical palpation yielded a sensitivity, specificity, positive, negative predictive value and accuracy as 68.7%, 87.5%, 91.6%, 58.3% and 75%. USG is a reliable and valuable tool for metastatic lymph node screening in head and neck cancer patients. It is a cheap, noninvasive, easy-to-handle and cost-effective diagnostic method. USG performed better than clinical palpation in detecting cervical metastatic nodes.

Primary mucosal sinonasal melanoma—Case report and review of the literature. The role of complex treatment-surgery and adjuvant radiotherapy

Aim The place of adjuvant radiotherapy in the treatment of sinonasal melanoma. Background Sinonasal mucosal melanoma is a rare disease with poor prognosis and requires a complex treatment. Elective neck dissection in patients with N0 and adjuvant radiotherapy has been a source of controversy. High late regional recurrence rates rise questions about elective irradiation of the neck nodes in patients with N0 stage disease. Methods We present our two years’ follow up in a case of locally advanced sinonasal melanoma and literature review of the treatment options for mucosal melanoma. Results In locally advanced sinonasal melanoma treated with surgical resection, postoperative radiotherapy and chemotherapy we had local tumor control. Two years later, a regional contralateral recurrence without distant metastasis occurred. Conclusions Literature data for frequent neck lymph nodes recurrences justify elective neck dissection. Postoperative elective neck radiotherapy for patients with locally advanced sinonasal melanoma and clinically N0 appears to decrease the rate of late regional recurrences.