Effect of sentinel lymph node biopsy on head and neck skin cancer

The aim of this research was to analyze the effect of a diagnostic procedure known as  sentinel lymph node biopsy on survival in patients with head and neck skin cancer.

Melanoma is a type of cancer that starts in color-producing cells of the skin. It can grow deep into the inner layers of skin and spread into lymph nodes (tiny, bean-shaped organs that help fight infections). Depending upon how deep a melanoma reaches into the skin layer (also called thickness), treatment is determined. A sentinel lymph node biopsy (SLNB) is a procedure to find out if the skin cancer has reached the lymph nodes. This helps determine the stage of the cancer and also to classifiy of prognosis (suggested outcomes of disease). In head and neck melanoma, this procedure sometimes poses risk with low survival benefit.

All patients had primary head and neck melanoma with a tumor thickness of 1mm or greater. A total of 259 patients with SLNB were compared with 218 patients without SLNB with regard to extent of cancer spreading (metastases), disease-free survival (survival without disease) and overall survival. In patients whose SNLB returned positive (cancer detected in the lymph nodes), surgery was performed to remove lymph nodes (lymphadenectomy) and return of cancer was analyzed during an average 50-month follow-up.

After 10 years, 63.4% of patients who had a SLNB had no disease recurrence compared to 54.8% of those who did not have a SLNB.  Those who had a SLNB were significantly less likely to have their first cancer recurrence to nearby lymph nodes (8.9% of patients) compared to those who did not have a SLNB (13.8% of patients). Also, those who had a SLNB were significantly less likely to have their first cancer recurrence at distant sites (metastatic recurrence) (7.3% of patients) compared to those who did not have a SLNB (12.4% of patients).

For those who did undergo a SLNB, 62.1 % of patients with positive SLNB experienced recurrence compared to 20% of negative SLNB patients. 

The authors concluded that SLNB is an important diagnostic procedure for accurate staging of head and neck cancer, potentially leading to improved disease outcomes as a result. 

The safety of SLNB in head and neck is a matter of concern and should be taken into consideration. Due to technical challenges involved in the procedure, incidence of false-negative SLNB (an incorrecnt conclusion that no cancer is present in the lymph nodes) is high in head and neck melanoma compared to other types.