Sentinel lymph node biopsy for cutaneous head and neck malignancies

Abstract

Sentinel lymph node biopsy (SLNB) is a procedure that can provide critical information regarding pathologic lymph node status and accurate regional staging. This is very important for developing treatment plans and providing prognostic guidance for cutaneous malignancies. The head and neck (HN) region is unique from other body sites due to its complex lymphatic drainage pathways, multiple lymph node basins, proximity of important cranial nerves and potential for contralateral or bilateral drainage. These unique aspects of the HN previously created some uncertainty about the use of SLNB in the HN. This review will discuss the current reliable status of HN SLNB and provide a guide for its current application in cutaneous malignancy of the HN.

Keywords:

• cutaneous squamous cell carcinoma
• head and neck cancer
• lymph node metastasis
• melanoma
• Merkel cell carcinoma
• sentinel lymph node biopsy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Sentinel lymph node biopsy (SLNB) in the head and neck (HN) is safe and reliable.

• Lymphoscintigraphy combined with single-photon emission computed tomography/computerized tomography and use of the hand-held γ probe are important tools to increase the success of HN SLNB.

• Single-photon emission computed tomography/computerized tomography is particularly important for distinguishing parotid from level II nodes as well as EJ from IJ nodes.

• SLNB should be applied based on histologic features and not avoided due to location near midline or potential for parotid drainage basin.

• Clear guidelines exist for the application of SLNB in melanoma.

• SLNB has an evolving role in the management of cutaneous squamous cell carcinoma and should be considered for lesions that have features which increase the risk of occult lymph node metastasis.

• SLNB for Merkel cell carcinoma can provide important guidance for management but must be used in the context of a multidisciplinary group to be sure the information gained from the procedure will impact management.

• SLNB can be used for periocular tumors including those on the conjunctiva.

Notes

Adapted from [86,87].

Adapted from [86].