Therapeutic neck dissection in head and neck melanoma patients: Comparing extent of surgery and clinical outcome in two cohorts |
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| Affiliation: | 1. Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands;2. Department of Surgical Oncology, Erasmus MC-Cancer Institute, Rotterdam, the Netherlands;3. Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands;4. Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands;5. Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, the Netherlands;6. Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands;1. Department of Gynecology and Obstetrics of Parma, 43125, Parma, Italy;2. Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy;1. Department of Surgery, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada;2. Department of Surgery, University of Montreal, Montreal, QC, Canada;3. Department of Gynecology & Obstetrics, University of Montreal, Montreal, QC, Canada;1. Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA;2. University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA;3. European Interbalkan Medical Center, Asklipiou 10, Pilea 555 35m, Thessaloniki, Greece;4. Athens Medical Center, Distomou 5-7, Athens, 151 25, Greece;1. TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;2. Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;3. Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden;4. Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden |
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| Abstract: | BackgroundThe extent of surgical management of regional lymph nodes in the treatment of cutaneous head and neck melanoma on and anterior to O'Brien's watershed line is controversial. By comparing patients' cohorts of two separate melanoma expert centers we investigate the effectiveness of comprehensive versus (super-) selective neck dissection approach.MethodsSixty patients with macroscopic (palpable) neck node metastases (N2b) from anterior scalp and face melanoma were retrospectively studied. Forty therapeutic modified radical neck dissections (MRND; levels I–V) combined with elective parotidectomy from The Netherlands Cancer Institute (NCI) were compared with 16 (super-) selective neck dissections [(S)SND; 3–4 levels] and 4 solely MRNDs from Erasmus Medical Center (EMC). Cohorts were analyzed for site of recurrence, overall survival (OS), melanoma-specific survival (MSS), and disease-free survival (DFS).ResultsClinical characteristics of patients were equal in both groups. In the NCI cohort 62.5% (n = 25) of patients recurred versus 65% (n = 13) in the EMC cohort. None of the NCI recurrences affected the parotid gland in contrast to 3 patients in the EMC group. Survival characteristics were not different between the two groups: OS (p = 0.56), MSS (p = 0.98), DFS (p = 0.92).ConclusionThis study does not support to continue the practice of routine elective parotidectomy and MRND in melanoma patients undergoing a lymph node dissection for macroscopic (palpable) nodal disease and justifies (S)SND. |
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| Keywords: | Melanoma Metastasis Head and neck Parotid gland Parotidectomy Therapeutic lymph node dissection |
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