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LEVEL I SPARING RADICAL NECK DISSECTIONS FOR CUTANEOUS MELANOMA IN THE LYMPHOSCINTIGRAM ERA
Rajendra Sawh-Martinez, BS, Britt Colebunders, M.D., Bernard Salameh, MD, Laura Tom, BS, Salem Samra, MD, Carolyn Truini, BS, Stephan Ariyan, MD, Deepak Narayan, MD.
Yale New Haven Hospital, New Haven, CT, USA.
Background: Crile originally reported the technique of performing a radical neck block dissection in 1905, with modifications to the extensive dissection reported throughout the 20th century. These modifications have aimed to reduce the morbidity encountered by performing the radical neck dissection while balancing the need to remove diseased structures in the head and neck. In this report we evaluate the outcomes of performing a functional radical neck dissection while sparing the level I lymph nodes as indicated by lymphoscintigraphy.
Methods: The charts of 301 patients from the Yale Melanoma Unit who underwent resection of their head and neck melanoma were reviewed. Those patients that underwent neck dissections were documented and the extent of the dissections from the operative reports was noted. Demographic and clinical outcome data were recorded. Student’s t-test and chi-square tests were used to determine statistical significance between groups. P-values less than 0.05 were considered statistically significant.
Results: A total of 41 patients who were documented to have had a head and neck primary melanoma underwent a functional radical neck dissection. Level I dissections were deemed necessary in 39% of these cases, while 61% of patients received functional radical neck dissections with sparing of Level I lymph nodes. Specific recurrence of melanoma in the submandibular basin was equivocal for lymph node sparing dissections (n=1) as compared to excision of level I LN's (n=1) (4% vs 6.25%, P= 0.488). Follow-up metastatic rates between the two groups were also comparable (44% vs 56%, p= 0.328).
Conclusions: Our results indicate that if lymphoscintigraphy does not show drainage to level I LN's, the functional radical neck dissection can be tailored to spare level I lymph nodes without affecting local recurrence. When not indicated by lymphoscintigram, sparing of level I nodes can be achieved safely without changing clinical outcomes, while saving operating room time and minimizing potential damage to the buccal branch of facial nerve and the submandiblular gland.
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