Journal of plastic, reconstructive & aesthetic surgery : JPRAS · 2026
Risk stratification prior to neck dissection for stage III or higher head and neck malignant melanoma: A retrospective UK study of 83 neck dissections.
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Adala Embiye, Thomson Hamish, Tsai Po-Hsien, Harper-Machin Aenone, Jones Christopher
Аннотация
BACKGROUND: Head and neck (H&N) melanomas account for approximately one-fifth of cutaneous melanomas and carry higher mortality owing to complex lymphatic drainage and increased invasiveness. However, predictors of nodal metastasis specific to this region remain poorly defined.
OBJECTIVES: To identify clinicopathological predictors of nodal metastasis in patients undergoing neck dissection for H&N melanoma.
METHODS: A retrospective cohort study of 83 patients undergoing neck dissection at Whiston Hospital (2017-2025), classified as ND-positive (n=45) or ND-negative (n=38). Univariable and multivariable logistic regression with Firth's penalised MLE, Kaplan-Meier survival analysis, and Cox proportional hazards regression were performed.
RESULTS: Larger tumour size (median 16.0 vs 10.0 mm, p=0.011), greater Breslow thickness (3.9 vs 2.3 mm, p=0.017) and lymphovascular invasion (26.3 vs 5.4%; OR 6.25, p=0.014) were significantly associated with ND-positive outcome. Cumulative epithelioid morphology across all preoperative biopsies was the sole independent predictor of nodal metastasis (aOR 25.67, 95% CI 3.55-185.60, p=0.001). Among sentinel lymph node biopsy (SLNB)-positive patients, larger metastatic deposit size (3.0 vs 0.6 mm, p=0.014) and subcapsular deposit diameter (3.0 vs 0.5 mm, p=0.015) predicted ND-positive outcome. Eight patients developed nodal metastasis despite negative SLNB.
CONCLUSIONS: Cumulative epithelioid morphology assessment is the strongest independent predictor of nodal metastasis in H&N melanoma. The high SLNB false-negative rate in this region supports risk-adapted surveillance imaging regardless of SLNB status, with early therapeutic neck dissection considered in selected high-risk cases.
OBJECTIVES: To identify clinicopathological predictors of nodal metastasis in patients undergoing neck dissection for H&N melanoma.
METHODS: A retrospective cohort study of 83 patients undergoing neck dissection at Whiston Hospital (2017-2025), classified as ND-positive (n=45) or ND-negative (n=38). Univariable and multivariable logistic regression with Firth's penalised MLE, Kaplan-Meier survival analysis, and Cox proportional hazards regression were performed.
RESULTS: Larger tumour size (median 16.0 vs 10.0 mm, p=0.011), greater Breslow thickness (3.9 vs 2.3 mm, p=0.017) and lymphovascular invasion (26.3 vs 5.4%; OR 6.25, p=0.014) were significantly associated with ND-positive outcome. Cumulative epithelioid morphology across all preoperative biopsies was the sole independent predictor of nodal metastasis (aOR 25.67, 95% CI 3.55-185.60, p=0.001). Among sentinel lymph node biopsy (SLNB)-positive patients, larger metastatic deposit size (3.0 vs 0.6 mm, p=0.014) and subcapsular deposit diameter (3.0 vs 0.5 mm, p=0.015) predicted ND-positive outcome. Eight patients developed nodal metastasis despite negative SLNB.
CONCLUSIONS: Cumulative epithelioid morphology assessment is the strongest independent predictor of nodal metastasis in H&N melanoma. The high SLNB false-negative rate in this region supports risk-adapted surveillance imaging regardless of SLNB status, with early therapeutic neck dissection considered in selected high-risk cases.