Staibano Phillip, Xie Michael, Abdallah Zahra, Nguyen Sofia, Au Michael, Zhou Kelvin, Bensky Hailey, Gupta Michael K, Choi David L, Lewis Trevor A, Young J E M Ted, Zhang Han
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Department of Health Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Am Surg. 2025 Jul;91(7):1156-1162. doi: 10.1177/00031348251323707. Epub 2025 Apr 2.
BackgroundCutaneous head and neck melanoma (cHNM) has a high rate of false-negative sentinel lymph node biopsy (SLNB) and up to a 25% risk of recurrence despite negative SLNB. The aim of this study was to investigate the pattern of melanoma recurrence in patients with cHNM with negative SLNB.MethodsA retrospective cohort study of consecutive cHNM patients at a tertiary care centre from 2014-2022. We included all cHNM patients with negative SLNB. All patients were categorized into Breslow thickness >2 mm and ≤2 mm and extracted information pertaining to histopathological characteristics and the presence and type of disease recurrences. We performed multivariable analysis using logistic and cox regression. We used an alpha of 0.05 and all statistical analyses were performed using R software.ResultsOverall, 167 patients met eligibility criteria and of these, 53.5% patients had cHNM ≤2 mm thick and 46.7% had lesions >2 mm thick. The overall recurrence rate was 29.3%. Multivariable analysis demonstrated that Breslow thickness [aOR: 5.89 (95% CI: 1.37, 32.3), = 0.02] was associated with distant recurrence. Multivariable cox regression also identified that pathological ulceration [aHR: 3.17 (95% CI: 1.61, 7.66), = 0.01] predicted time to distant recurrence. The SLNB false omission rate was 3.6% (95% CI: 1.3%, 7.7%).ConclusionSLNB-negative cHNM patients with high-risk pathological features may benefit from adjuvant immunotherapy.
背景
皮肤头颈黑色素瘤（cHNM）前哨淋巴结活检（SLNB）假阴性率高，且即使SLNB结果为阴性，仍有高达25%的复发风险。本研究旨在调查SLNB结果为阴性的cHNM患者的黑色素瘤复发模式。
方法
对2014年至2022年在一家三级医疗中心连续就诊的cHNM患者进行回顾性队列研究。我们纳入了所有SLNB结果为阴性的cHNM患者。所有患者根据Breslow厚度分为>2 mm和≤2 mm两组，并提取有关组织病理学特征以及疾病复发的存在和类型的信息。我们使用逻辑回归和Cox回归进行多变量分析。我们设定α为0.05，所有统计分析均使用R软件进行。
结果
总体而言，167例患者符合纳入标准，其中53.5%的患者cHNM厚度≤2 mm，46.7%的患者病变厚度>2 mm。总体复发率为29.3%。多变量分析表明，Breslow厚度[aOR：5.89（95%CI：1.37，32.3），P = 0.02]与远处复发相关。多变量Cox回归还确定，病理溃疡[aHR：3.17（95%CI：1.61，7.66），P = 0.01]可预测远处复发时间。SLNB假漏诊率为3.6%（95%CI：1.3%，7.7%）。
结论
具有高危病理特征的SLNB阴性cHNM患者可能从辅助免疫治疗中获益。
