The pathologic status of the sentinel node is the most important prognostic determinant of disease recurrence and death from melanoma for intermediate-thickness melanoma. The role of completion lymph node dissection in patients with a positive sentinel node biopsy has, until recently, been less well defined. A review of key literature was undertaken to study the evidence for management of the parotid/neck following a positive sentinel node biopsy in patients with cutaneous melanoma of the head and neck. Immediate completion lymph node dissection following a positive sentinel node biopsy in the head and neck results in improved regional control, leading to significantly better disease-free survival, but does not offer a melanoma-specific survival benefit over observation followed by subsequent salvage surgery if required. Completion lymph node dissection should no longer be routine following a positive sentinel node biopsy. However, it may be recommended in cases with the high risk features of extranodal extension, concomitant microsatellitosis of the primary tumor, more than two involved nodal basins, and immunosuppression. The increasingly common practice of administering adjuvant immunotherapy following a positive sentinel node also lends support to not performing an immediate completion lymph node dissection following a positive sentinel node biopsy.
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