Samra Salem, Sawh-Martinez Rajendra, Tom Laura, Colebunders Britt, Salameh Bernard, Truini Carolyn, Ariyan Stephan, Narayan Deepak
Section of Plastic Surgery, Department of Surgery, Yale University, New Haven, CT, USA.
Ann Plast Surg. 2012 Oct;69(4):415-7. doi: 10.1097/SAP.0b013e31824a21af.
Cutaneous melanoma is on the rise in the United States, and the head and neck region is the primary site in 20% of patients. Lymph node status is the best indicator of prognosis for melanoma. In the head and neck, sentinel lymph node (SLN) biopsy presents particular challenges, with the parotid region posing difficulties that include locating the lymph nodes, less frequent visualization of blue dye, and the possibility of higher morbidity because of the proximity of lymph nodes to important neurovascular structures. Surgical approaches to the SLN dissection in the parotid region are variable, and may include superficial or total parotidectomies. Parotid-sparing SLN biopsies for head and neck melanomas were evaluated to determine rates of local recurrence.
The charts of 301 patients from the Yale Melanoma Unit who underwent resection of their head and neck melanoma were reviewed. The location of the primary melanoma was noted, and the sentinel lymph node dissections from the operative reports were documented. Demographic and outcome data were recorded, including course of melanoma management, local recurrence, and postoperative course.
Fifty-eight patients underwent SLN biopsy of lymph nodes in the parotid region. Parotid-sparing SLN biopsies comprised 94.8% of total surgical approaches for SLN biopsies in the parotid region. Of the remaining patients who underwent SLN biopsies in the parotid region, 5.17% had a superficial parotidectomy and none had a total parotidectomy. Sentinel lymph nodes were found in all depth layers of the parotid, and LNs were dissected out successfully without the need to remove the parotid in the most cases. The parotid region recurrence rate was 0% for SLN biopsies that either included or spared the parotid gland. There were no localized complications from the sentinel lymph node biopsies.
The parotid-sparing SLN biopsy was performed without any local recurrence in the parotid region. The parotid-sparing SLN biopsy can be carried out in a safe, efficient manner without affecting the rate of local recurrence or postoperative complication. This less-invasive SLN biopsy procedure precludes the complications associated with parotidectomies and may reduce the morbidity for patients with melanomas of the head and neck.
在美国，皮肤黑色素瘤的发病率呈上升趋势，头颈部是20%患者的主要发病部位。淋巴结状态是黑色素瘤预后的最佳指标。在头颈部，前哨淋巴结（SLN）活检面临特殊挑战，腮腺区域存在诸多困难，包括淋巴结定位、蓝色染料显影不常见以及由于淋巴结靠近重要神经血管结构而导致更高发病率的可能性。腮腺区域SLN清扫的手术方法各不相同，可能包括浅叶或全腮腺切除术。对保留腮腺的头颈部黑色素瘤SLN活检进行评估，以确定局部复发率。
回顾了耶鲁黑色素瘤中心301例接受头颈部黑色素瘤切除术患者的病历。记录原发性黑色素瘤的位置，并记录手术报告中的前哨淋巴结清扫情况。记录人口统计学和结局数据，包括黑色素瘤的治疗过程、局部复发情况和术后过程。
58例患者接受了腮腺区域淋巴结的SLN活检。保留腮腺的SLN活检占腮腺区域SLN活检总手术方法的94.8%。在其余接受腮腺区域SLN活检的患者中，5.17%进行了浅叶腮腺切除术，无人进行全腮腺切除术。在腮腺的所有深度层面均发现了前哨淋巴结，大多数情况下无需切除腮腺即可成功切除淋巴结。包括或保留腮腺的SLN活检的腮腺区域复发率为0%。前哨淋巴结活检无局部并发症。
保留腮腺的SLN活检在腮腺区域未出现任何局部复发。保留腮腺的SLN活检可以安全、有效地进行，不影响局部复发率或术后并发症发生率。这种侵入性较小的SLN活检程序避免了与腮腺切除术相关的并发症，可能降低头颈部黑色素瘤患者的发病率。
