Abstract
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 be performed accurately in the parotid region and offers a low-morbidity alternative to routine elective superficial parotidectomy.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
REFERENCES
Balch CM, Milton GW, Cascinella N, et al. Elective lymph node dissection: pros and cons. In: Balch CM, Houghton A, Milton GW, et al., eds. Cutaneous melanoma, 2nd ed. Philadelphia: JB Lippincott, 1992:345–66
Veronesi U. Efficacy of immediate node dissection of stage II melanoma. N Engl J Med 1977;2:627–30
Sim FH, Taylor WF, Ivins JC, Pritchard DJ, Soule EH. A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma. Cancer 1978; 41:948–56
Balch CH, Soong S-J, Bartolucci AA, et al. Efficacy of an elective regional lymph node dissection of 1 to 4 mm thick melanomas for patients 60 years of age and younger. Ann Surg 1996;224:255–66.
Morton DL, Wen DR, Wong JM, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–9.
Morton DL, Wen DR, Foshag LJ, Essner R, Cochran A. Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck. J Clin Oncol 1993;11:1751–6.
Wells KE, Rapaport DP, Cruse CW, et al. Sentinel lymph node biopsy in melanoma of the head and neck. Plast Reconstr Surg 1997;100:591–4.
Bostick P, Essner R, Sarantou T, et al. Intraoperative lymphatic mapping for early-stage melanoma of the head and neck. Am J Surg 1997;174:536–9.
Alex JC, Weaver DL, Fairbank JT, Rankin BS, Krag DN. Gammaprobe- guided lymph node localization in malignant melanoma. Surg Oncol 1993;2:303–8.
Wells KE, Cruse CW, Daniel S, Berman C, Norman J, Reintgen DS. The use of lymphoscintigraphy in melanoma of the head and neck. Plast Reconstr Surg 1994;93:757–61.
Albertini JJ, Cruse CW, Rapaport D, et al. Intraoperative radiolymphoscintigraphy improves sentinel lymph node identification for patients with melanoma. Ann Surg 1996;223:217–24.
O’Brien CJ, Petersen-Schafer K, Papadopoulos T, Malka V. Evaluation of 107 therapeutic and elective parotidectomies for cutaneous melanoma. Am J Surg 1994;168:400–3.
Nasri S, Namazie A, Dulguerov P, Mickel R. Malignant melanoma of cervical and parotid lymph nodes with an unknown primary site. Laryngoscope 1994;104:1194–8.
Barr LC, Skene AI, Fish S. Superficial parotidectomy in the treatment of cutaneous melanoma of the head and neck. Br J Surg 1994;81:64–5.
Ang KK, Byers RM, Peters LJ, et al. Regional radiotherapy as adjuvant treatment for head and neck malignant melanoma. Arch Otolaryngol Head Neck Surg 1990;116:169–72.
O’Brien CJ, Uren RF, Thompson JF, et al. Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy. Am J Surg 1995;170:461–6.
Norman J, Cruse CW, Espinosa C, et al. Redefinition of cutaneous lymphatic drainage with the use of lymphoscintigraphy for malignant melanoma. Am J Surg 1991;162:432–7.
Author information
Authors and Affiliations
Additional information
Supported by Grants CA12562 and CA29605 from the National Cancer Institute and by funding from the Wrather Family Foundation (Los Angeles, CA).
Presented at the 51st Annual Cancer Symposium of The Society of Surgical Oncology, San Diego, California, March 26-29, 1998.
Rights and permissions
About this article
Cite this article
Ollila, D.W., Foshag, L.J., Essner, R. et al. Parotid Region Lymphatic Mapping and Sentinel Lymphadenectomy for Cutaneous Melanoma. Ann Surg Oncol 6, 150–154 (1999). https://doi.org/10.1007/s10434-999-0150-0
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10434-999-0150-0