Completion Node Dissection in Patients with Sentinel Node-Positive Melanoma of the Head and Neck

Objective. Determine if completion lymph node dissection (CLND) is associated with improved survival in sentinel lymph node (SLN)-positive cutaneous melanoma of the head and neck (CMHN) patients. Study Design. Retrospective analysis of large population database. Setting. Surveillance, Epidemiology and End Results (SEER) database/multiple settings. Subjects and Methods. Using the SEER database, the authors identified patients with SLN-positive CMHN. Clinicopathologic data and 5-year disease-specific survival (DSS) were examined for patients who underwent sentinel lymph node biopsy (SLNB) alone vs SLNB + CLND. Results. Among 350 SLN-positive patients, 210 (60%) had SLNB + CLND, and 140 (40%) had SLNB only. Patients in the SLNB-only group were significantly older (median age 62 vs 53 years, P < .0001). The cohort as a whole did not significantly benefit from CLND; however, CLND was associated with improved DSS for a subgroup of patients age < 60 years with nonulcerated tumors <= 2 mm thick (P = .03). Relative to SLNB alone, CLND did not improve survival for patients age >= 60 years or those with thicker (> 2 mm) or ulcerated tumors. Conclusions. Compared with SLNB alone, CLND does not seem to be associated with improved survival for most patients with SLN-positive CMHN. CLND likely improves survival for patients age < 60 years with thin (<= 2 mm) nonulcerated tumors and when there is a low risk of identifying positive non-SLNs.