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Sentinel Lymph Node Biopsy After Wide Local Excision for Melanoma of the Head and Neck

By: Melissa E. Fryman, MS
Posted: Friday, May 17, 2019

Prior wide local excision may not adversely affect the identification of sentinel lymph nodes in patients with melanoma of the head and neck, according to a study by Matthew M. May, MD, and colleagues, of the Mayo Clinic School of Medicine, Rochester, Minnesota. Published in the International Journal of Dermatology, the research compared regional recurrence rates in patients who had wide local excision, versus other biopsies, and measured survival outcomes in those with head and neck cancer.

In this single-center study, 391 primary cutaneous melanoma biopsy cases were reviewed. Biopsy types included the following: shave (28%), punch (18%), wide local excision (8%), narrow margin excision/Mohs (27%), and unknown (19%); they were followed by sentinel lymph node biopsy. The median follow-up was 30 months.

In total, the sentinel lymph node was identified in 97% of patients. The depth of biopsy types varied significantly (P < .001), with a median depth of 2.5 mm for wide local excision, 2.2 mm for excisional, and 1.6 mm for both punch and shave biopsies. No significant difference was found in terms of local or regional recurrence among biopsy types. However, 4 of the patients with prior wide local excision experienced regional recurrence, at a median of 0.7 years. The investigators noted that this finding “could indicate that the true sentinel lymph node may have been missed in these patients.”

“We continue to recommend that patients with prior [wide local excision] may still benefit from [sentinel lymph node biopsy] procedures,” the authors concluded.

Disclosure: The study authors’ disclosure information may be found at

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