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Head and Neck Melanoma SLNB — SCE Dermatology MCQ

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HardSkin CancerHead and Neck Melanoma SLNBSCE Dermatology

A 55-year-old man with a melanoma on his temple has a positive SLNB. His melanoma is in the head and neck region. What specific challenge does SLNB pose in the head and neck?

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Correct answer: C — The head and neck has complex lymphatic drainage with multiple potential sentinel nodes, higher false-negative rates than truncal/extremity melanomas, and proximity to vital structures making the procedure technically more challenging

SLNB in the head and neck region is technically more challenging than on the trunk or extremities due to: complex and variable lymphatic drainage (multiple first-echelon nodal basins, bilateral drainage, potential parotid node involvement), proximity to vital structures (facial nerve, spinal accessory nerve, major vessels), higher false-negative rates (approximately 10-15% vs 5% for trunk), and the cosmetic sensitivity of the area. SPECT-CT lymphoscintigraphy improves sentinel node identification in the head and neck. Despite these challenges, SLNB remains recommended for staging head and neck melanomas ≥0.8 mm as the prognostic information guides adjuvant therapy decisions.

Reference: BAD 2017 Melanoma; NICE NG14