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Management of the Parotid/Neck Following a Positive Sentinel Node Biopsy in Patients with Cutaneous Melanoma of the Head and Neck

  • Sydney Ch’ng
  • Eileen Tan-Gore
  • John F. Thompson
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

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.

Keywords

Melanoma Completion lymph node dissection Neck dissection Parotidectomy Sentinel node biopsy 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sydney Ch’ng
    • 1
    • 2
    • 3
    • 4
  • Eileen Tan-Gore
    • 4
  • John F. Thompson
    • 1
    • 2
    • 3
  1. 1.Melanoma Institute of AustraliaSydneyAustralia
  2. 2.Sydney Medical SchoolUniversity of SydneySydneyAustralia
  3. 3.Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyAustralia
  4. 4.Head and Neck SurgeryChris O’Brien Lifehouse Cancer CentreSydneyAustralia

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