U. MICHIGAN (US) — A common procedure is not only safe for diagnosing melanomas in the head and neck, but can also help determine the most effective course of treatment.
Sentinel lymph node biopsy involves injecting a special dye to identify the first node where cancer would likely spread. If that node is clean, patients can avoid further debilitating surgery to remove multiple lymph nodes.
If the node shows cancer, patients know they need more extensive surgery or further treatment with radiation, chemotherapy, or a clinical trial. Patients with larger melanomas are routinely offered this procedure.
Previously many surgeons believed that the complex anatomy combined with the critical nerves and blood vessels in the head and neck area made sentinel lymph node biopsy unsafe and inaccurate for melanomas in that region.
In the current study, published online in the journal Cancer, researchers looked at 353 head and neck melanoma patients who had received sentinel lymph node biopsy over a 10-year period.
A review of patients’ records, showed the sentinel lymph node could be identified in all but one patient, and no patients sustained permanent nerve injuries during the procedure.
About 20 percent of the patients had at least one sentinel node positive for cancer and were referred for a complete dissection to remove additional lymph nodes.
Among the remaining 283 patients with negative sentinel nodes, 12 patients recurred in the region where the sentinel lymph node was identified. This suggests that the test yielded 12 false-negative results, which means a negative test was incorrect 4 percent of the time—a rate similar to when sentinel lymph node biopsy is used for melanomas in other parts of the body.
“Sentinel lymph node biopsy is a safe and effective way to determine the status of the regional nodal basin for melanomas affecting the head and neck region,” says study author Carol Bradford, professor of otolaryngology at the University of Michigan. “Furthermore, our study showed that it can be done accurately for these patients.”
Sentinel lymph node biopsy was also found to be the biggest predictor of how well a patient would do after surgery, including overall survival as well as recurrence-free survival.
“This procedure should be offered in patients with head and neck melanomas the same as patients with melanomas in other parts of the body,” Bradford says.
“Not only is sentinel lymph node biopsy feasible and safe in these patients, but it helps determine the best course of treatment to offer patients the best hope of survival.”
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