Impact of Nodal Yield and Dissection Extent on Regional Control in Head and Neck Melanoma

Sunday, October 18, 2026

8:30 AM - 8:36 AM PT

Location: West Exhibit Hall A, Learning Zone 3

Presenting Author(s)

ET

Evan A. Thomas, BS

Medical Student
University of Michigan Medical School
Ann Arbor, Michigan, United States

Co-Author(s)

Scott A. McLean, MD PhD

Clinical Associate Professor
University of Michigan
Ann Arbor, MI, United States
CS

Chaz L. Stucken, MD

Clinical Associate Professor
University of Michigan
Ann Arbor, Michigan, United States
Kelly Michele Malloy, MD, MBA

Professor and Chief Clinical Officer
University of Michigan/Michigan Medicine
Ann Arbor, MI, United States
Molly E. Heft Neal, MD

Assistant Professor
University of Michigan
Ann Arbor, MI, United States
MD

Michael J. Davis, MD

Clinical Assistant Professor
University of Michigan, United States

Senior Author(s)

DF

David WA Forner, MD MSc

Assistant Professor
University of Michigan
Ann Arbor, Michigan, United States

Introduction: Since the MSLT-II trial, the role and extent of completion lymph node dissection (CLND) in head and neck melanoma management have shifted toward more selective surgical strategies. We attempt to evaluate the impact of nodal yield and anatomic extent of neck dissection on regional control to better inform modern surgical decision-making.

Methods: This is a retrospective cohort study of sentinel lymph node biopsy (SLNB) positive patients who underwent CLND for primary cutaneous melanoma of the head and neck at a single tertiary care center from 2012 to 2020. Neck dissection was characterized by nodal yield based on previous literature (<=20 vs >20 nodes) and anatomic levels included. The primary outcome was regional recurrence and regional recurrence free survival. Unadjusted Cox proportional hazards regressions were used to estimate hazard ratios (HR) for primary outcomes.

Results: Fifty-four patients underwent CLND from 2012 to 2020. The median follow-up time was 53.8 months (range, 1–130 months). Median regional recurrence-free survival was 17.9 months (range, 1–119 months). Regional control was obtained in 47 patients (87%) at the time of analysis. The median nodal yield was 41 (range, 10–94 nodes). On univariable Cox proportional hazards analysis, higher nodal yield (>20 nodes removed) was associated with an 85% lower hazard of regional recurrence (HR=0.15, 95% CI: 0.03–0.80, p=0.026). Greater extent of neck dissection was similarly associated with an 87% lower hazard of regional recurrence (inclusion of levels I and/or V compared to levels II-IV alone; HR=0.13, 95% CI: 0.02–0.67, p=0.015).

Conclusions: Greater nodal yield and more extensive neck dissection were associated with improved regional recurrence-free survival after completion lymph node dissection. These findings suggest that surgical extent may influence regional disease control. However, given the limited number of recurrence events, results should be interpreted cautiously and warrant validation in larger, multi-institutional cohorts.