Up to a quarter of cutaneous melanomas occur in the head and neck region and these tend to have a worse prognosis when compared to other sites. Margin status and sentinel lymph node positivity are known to be prognostic factors. As a result, late recurrences in pN0 melanoma patients with adequate wide local excisions are rare. Little is known, however, about the potential long-term outcomes of this group of patients. The purpose of this study is therefore to assess the incidence and predictive factors for long-term recurrence of local-regional nodal metastases in previously negative sentinel lymph node biopsies in patients undergoing resection of cutaneous head and neck melanomas.
A single-center retrospective review of a prospective database of 318 consecutive patients from a tertiary cancer center with a pathological diagnosis of melanoma between 2007 and 2014 was conducted. Inclusion criteria included age >18 years old, pathological diagnosis of melanoma in patients who received negative margins following wide local excision with a negative sentinel lymph node biopsy. All patients with late recurrence, defined as greater than 5 years post-treatment, were included. Exclusion criteria included patients treated for palliative intent or those who had previous head and neck surgery/radiotherapy.
Fourteen (4.4%) patients developed recurrence after previous treatment for their cutaneous head and neck melanoma. The mean age at primary diagnosis of the late recurrence was 41.5 years. There was no statistically significant difference in gender (p=0.109) or melanoma histological subtype in late recurrence incidences (p>0.05). Age, pT-stage, Breslow depth, sentinel lymph node sampling, and number of sentinel lymph nodes sampled were statistically associated with late recurrences on univariate analysis (p<0.05). Multivariate analysis confirmed that age, pT-stage, Breslow depth, and sentinel lymph node sampling maintained an association with late recurrences (p<0.05).
Late recurrence in otherwise sentinel lymph node negative head and neck melanoma is rare. Age, pT-stage, Breslow depth, and sentinel lymph node sampling on initial treatment appear to be associated with increased incidences.