Dilemma of clinically node-negative head and neck melanoma: Outcome of "watch and wait" policy, elective lymph node dissection, and sentinel node biopsy - A systematic review

The management of patients with clinically nodenegative melanoma of the head and neck remains controversial. This is a systematic review of management strategies for stage 1 head and neck melanoma. Subgroup analysis of 1 randomized controlled trial (RCT) and most available cohort studies do not reveal a significant impact of elective neck dissection on survival. For 1.2- to 3.5-mm-thick melanoma at all anatomical sites, 1 RCT does not show an overall significant melanoma-specific survival benefit of sentinel node biopsy, but subgroup analysis suggests a survival benefit for lymph node-positive patients, confirming findings from 3 retrospective series. Sentinel node biopsy in the head and neck region can be technically demanding, with lower identification rates and higher false-negative rates. There is no conclusive survival advantage of either elective neck dissection or sentinel node biopsy in patients with clinically nodenegative head and neck melanoma of intermediate thickness. (c) 2008 Wiley Periodicals, Inc.