Rates of complex lymphatic drainage, false negatives, and regional recurrence may be higher in head and neck melanoma (HNM) com- pared with other regions, accord- ing to findings published in JAMA Otolaryngology—Head and Neck Surgery. Amit Roshan, PhD, and colleagues examined the accuracy, prognostic value, and long-term outcomes of sentinel lymph node biopsy (SLNB) in HNM compared with melanoma of the trunk and limb among 1,080 patients (median follow-up, 4.8 years). The false-negative rate (FNR) was highest in HNM (34.5%) compared with trunk (14.8%) or limb (10.4%) melanomas. While melanoma-specific survival (MSS) was no different, recurrence-free survival (RFS) was lower in HNM (HR, 0.55; 95% CI, 0.36-0.85). On lymphoscintigraphy (LSG), patients with HNM had the highest proportion of multiple hotspots (28.6% with ≥3 hotspots vs trunk [23.2%] and limb [7.2%]). The RFS was lower for patients with HNM with three or more affected lymph nodes found on LSG than for those with less than three (HR, 0.37; 95% CI, 0.18-0.77).
