Melanoma in the head and neck region: the value of preoperative imaging in melanoma stage I–II

The management of head and neck melanoma (HNM) is constantly being fine-tuned in the era of immunotherapy. HNM have different metastatic patterns and a worse prognosis than melanoma of the trunk, asking for a more fine-tuned managing strategy. In clinically node-negative HNM patients, the ultrasound (US) with fine needle aspiration cytology (FNAC) and chest X-ray (CXR) are optional modalities in the preoperative staging workup. The contribution of imaging seems limited in this stage of disease. This study aims to research the value of the US-FNAC and CXR in clinically node-negative HNM patients. Clinical stage I-II HNM patients from 2016 to 2021 were retrospectively reviewed. A total of 373 patients were analyzed. Patient characteristics, surgery and follow-up details, recurrences, tumor characteristics, staging, imaging, sentinel node procedure (SNP) details, and lab results were collected from the patient files. All patients received preoperative US. A total of 65 FNACs were performed, which found metastatic lymph nodes in two patients (0.54%). The CXR was performed in 336/373 patients and did not find any pulmonary metastases. The SNP was performed in 242 patients and demonstrated 40 positive patients, with 86% having micrometastases, isolated tumor cells, or submicrometastases. This study demonstrated a low number of relevant findings by both the US and CXR. We can conclude that both imaging modalities do not have a significant contribution to the routine staging procedure of clinical stage I-II HNM in our study group, with our results being in line with current general melanoma guidelines.