ArticleThe Laryngoscope2025
Survival Correlates With Adjuvant Choice in Sentinel Node Positive Head and Neck Cutaneous Melanoma.
Article in The Laryngoscope, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
OBJECTIVE(S): The objective of this study is to evaluate the utilization and outcomes of completion lymph node dissection (CLND) and immunotherapy for sentinel lymph node biopsy (SLNB) positive head and neck cutaneous melanoma (HNCM).
methodsPatients with primary HNCM and positive SLNB in the 2020 National Cancer Database (NCDB) Melanoma file were reviewed. The frequency of CLND and immunotherapy was tracked from 2012 to 2019. Clinicodemographic features of patients were evaluated with respect to their post-SLNB treatment choice. Overall survival (OS) was calculated from the time of diagnosis, and the association of therapy choice with survival was determined using a multivariate Cox regression analysis.
resultsThe rates of CLND declined from 66% to 18% while adjuvant immunotherapy increased to a peak of approximately 40%, with an inflection point occurring in 2016. Multivariate survival analysis indicated that immunotherapy use alone, though not CLND, was associated with improved prognosis (hazard ratio 0.65, 95% confidence interval 0.45-0.93). Patient characteristics associated with immunotherapy administration included age (p < 0.01), insurance type (p = 0.002), income (p < 0.001), and healthcare facility type (p = 0.005).
conclusionIn this retrospective NCDB-based study, we find that the modern management of SLNB-positive patients has shifted towards greater use of adjuvant immunotherapy and a decline in CLND; the use of immunotherapy is associated with improved OS. Patients treated with immunotherapy were more likely to be younger, of higher income, and with private health insurance. LEVEL OF EVIDENCE: 4:
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