Intraoperative lymphatic mapping (IOLM) and sentinel lymph node biopsy (SLNB) has emerged as a reliable and accurate method to stage adult patients with melanoma of the head and neck. However, the utility of IOLM and SLNB in head and neck melanoma in the pediatric population has not been established. The objective of this study was to determine the clinical utility of IOLM and SLNB of head and neck melanoma in the pediatric population. We reviewed the records of 7 pediatric patients with head and neck melanoma or borderline melanocytic proliferations of unknown biologic potential who underwent IOLM and SLNB between 1998 and 2001. All surgical nodal specimens were examined by a melanoma dermatopathologist for the presence of metastatic melanoma. The mean operative time for each case was 3hrs 8 min (range 2:15-3:50). All seven pediatric patients who underwent extirpation of a primary head and neck melanoma and preoperative lymphoscintigraphy had unique and identifiable basins of drainage to regional nodal groups. Four of the seven patients (57%) had at least 1 positive sentinel lymph node. Overall, five of the 19 nodes (26%) resected had evidence of metastatic melanoma. Of the patients with positive sentinel lymph nodes, two of the primary lesions were diagnosed as melanoma while two were considered atypical melanocytic proliferations of uncertain biologic potential. One (25%) of four patients had evidence of an additional positive lymph node from the theraupeutic lymph node dissection. Sentinel lymph nodes in pediatric patients with melanoma of the head and neck can be successfully mapped and biopsied similar to adult patients. In addition, this procedure can provide critical diagnostic information for those pediatric patients with diagnostically challenging, controversial or borderline melanocytic lesions.
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