The Utility of Sentinel Node Biopsy for
Sinonasal Melanoma
Michael Oldenburg, M.D1., Brandon Peck, M.D1, Brian Mullon M.D2, Daniel Price M.D1
Department of Otorhinolaryngology1 , Department of Radiology2
Mayo Clinic, Rochester, MN, USA
Figure 1: Lymphoscintigraphy and SPECT/CT
Abstract
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Objectives: Sinonasal melanoma is a rare malignancy with a high propensity for regional spread
and very poor long-term prognosis. Despite the proven benefit of sentinel node biopsy in
cutaneous melanoma there is a paucity of literature utilizing this in sinonasal malignancies. We
report the two cases positive sentinel node biopsies in sinonasal melanoma and perform a
literature review on sentinel node biopsy for sinonasal melanoma.
Design: Retrospective review
Methods: The electronic medical record was used to collect pertinent clinical information.
Results: Two patients were identified that met inclusion criteria. Patient one was an 83-year-old
gentleman who presented with recurrent epistaxis and was found to have a sinonasal melanoma
anterior to the left inferior turbinate. No clinical or radiological lymphadenopathy was detected
during initial evaluation. Pre-operatively, lymphoscintigraphy was performed with 0.39 mCi of
technetium-99. This revealed one sentinel node in the ipsilateral level I and level II cervical
basins as well as three sentinel nodes in the contralateral level II cervical basin. Intraoperatively,
methylene blue was used to co-localize the sentinel nodes and they were removed and sent to
pathology. Frozen section pathology of the left level I sentinel node was positive for melanoma
and a select neck dissection was performed during the same operation. Final pathology revealed
a 2.5 mm focus of melanoma in the sentinel node and the remaining lymph nodes were negative
for tumor.
Patient two was a 71-year-old female presented after incomplete resection of a sinonasal
melanoma of the left posterior maxillary sinus wall. Clinical exam, MRI and PET/CT did not show
evidence of metastasis. Lymphoscintigraphy was performed with SPECT/CT localization which
showed one sentinel node in the parapharyngeal space and another in the ipsilateral cervical
basin. Intraoperative frozen section revealed metastatic melanoma in both sentinel nodes.
Completion neck dissection did not reveal any additional site of metastatic melanoma.
Figure 1: Sentinel node biopsy for patient one with sinonasal melanoma
centered on the head of the left inferior turbinate. A) Lymphoscintigraphy
shows multiple ipsilateral and a single contralateral sentinel node. B) Gross
appearance of the left level 1 sentinel node with 2.5 mm positive focus of
melanoma
Figure 2: Lymphoscintigraphy and SPECT/CT
Conclusion: Sentinel node biopsy for sinonasal melanoma can provide crucial clinical evidence
of regional metastasis prior to overt clinical signs and symptoms. This intraoperative tool has the
potential to improve detection of regional metastasis and improve long-term outcomes of this
aggressive malignancy.
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Background and Objectives
• Hypothesis: Sentinel node biopsy (SNB) will offer a minimally invasive
approach to staging and treatment of the cervical nodal basin in sinonasal
melanoma
• Objectives: Report our initial experience with sentinel node biopsy for
sinonasal melanoma
Figure 2: Patient number two with lymphoscintigraphy and SPECT/CT scan.
A-B) show sentinel node in the ipsilateral parapharyngeal space which was
found to harbor metastatic melanoma. C) Second sentinel node in the
ipsilateral level 2 cervical area was also positive for metastatic melanoma.
Study Design
Conclusions
•This study reports successful sentinel lymph node biopsy in two patients
• Retrospective review
with sinonasal mucosal melanoma.
•We were able to identify and treat occult micrometastatic disease in both the
Results
• Two patients were identified that met inclusion criteria
• Patient one: had a SNB for an inferior turbinate lesion with ipsilateral
cervical basin and the parapharyngeal space.
•Sentinel node biopsy could be a valuable tool in the workup and treatment
of sinonasal malignancies
•Further evaluation into the reliability and clinical benefit of this technique are
required prior to widespread adaptation.
Level I and II nodes and contralateral level II sentinel nodes (Figure 1)
• Underwent same day lymphoscintigraphy with technetium-99m and
References
colocalization with methylene blue
• SNB showed metastatic melanoma in the ipsilateral level I cervical basin
• Completion cervical lymphadenectomy showed no other site of
metastasis
• Patient two: underwent SNB for a posterior maxillary sinus lesion
• Lymphoscintigraphy was performed with technetium-99m in the clinic the
day before surgical resection and was colocalized with SPECT/CT
(Figure 2) and methylene blue
• Ipsilateral parapharyngeal space and cervical sentinel nodes were
identified
• Both sentinel nodes were positive for metastatic melanoma on frozen
and permanent pathological sections
• Completion cervical lymphadenectomy showed no other site of
metastasis
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