Parotid region lymphatic mapping and sentinel lymphadenectomy for cutaneous melanoma

Background: Routine elective superficial parotidectomy for patients with primary cutaneous melanomas of the scalp, auricle, or Face has been questioned. We evaluated an alternative, i.e., lymphatic mapping and sentinel lymphadenectomy, for patients with primary cutaneous melanomas draining to the region of the parotid gland. Patients: Retrospective review of our large (>8000 patients) melanoma database identified 39 patients with primary melanomas (American Joint Committee on Cancer stage I or II) of the scalp (n = 19), auricle; (n = 11), or face (n = 9) who underwent intraoperative lymphatic mapping to identify a sentinel node (SN) in the region of the parotid gland, between June 1985 and July 1997. Results: A. SN was identified in the parotid region of 37 patients (94.9%), four of whom had SN metastases. The:mean number of SN obtained was 2.3/patient (range, 1-4/patient). The two patients (5.1%) for whom a parotid-region SN could not be identified underwent superficial parotidectomy during the same operation. Among the 33 patients with tumor-free SN, with a median follow-up period of 33.2 months (range, 1-121 months;), there was one (3.1%) intraparotid recurrence; thus, the false-negative rate was 3.1%. The procedure-related surgical morbidity rate was only 2.6% (one case of temporary facial nerve paresis). Conclusions: For patients with primary melanomas of the scalp, auricle, or face, sentinel lymphadenectomy can he performed accurately in the parotid region and offers a low-morbidity alternative to routine; elective superficial parotidectomy.