Intraparotid Sentinel Lymph Node Dissection for Melanoma: A Systematic Review and Meta-Analysis

Background: Surgical management of head and neck cutaneous melanoma (HNCM) has evolved tremendously since sentinel lymph node biopsy (SLNB) has become the prominent tool of prognosis and staging. This meta-analysis aimed to evaluate the safety and efficiency of intraparotid SLNB compared with a more extensive surgery of superficial parotidectomy (SP). Methods: The electronic database of PubMed and Scopus were searched for publications until 10 March 2022. In addition, the study included data of patients from our institution who underwent cherry-picking procedures. Pooled estimates were calculated using the random-effects model. Heterogeneity was calculated using the I² test. Results: The pooled result regarding the rate of SLNB excision success was 97 % (95 % confidence interval [CI], 0.95–0.99; p < 0.0001), and the pooled probability of a positive SLNB result was 16 % (95 % CI 0.12–0.20; p < 0.0001). Failure of SLNB had pooled results of 4 % (95 % CI 0.02–0.06; p < 0.0009). For SP, no study examining N0 HNCM patients has met the authors’ inclusion criteria. Cherry-picking SLNB had temporary and permanent facial nerve paralysis relative risks (RRs) of 0.12 (95 % CI 0.06–0.27; p < 0.0001) and 0.46 (95 % CI 0.17–1.22; p < 0.0001), respectively, compared with historical data from four weighted meta-analyses of SP. Conclusions: The data from this study suggest that intraparotid SLNB performed for N0 HNCM patients is a safe and reliable procedure, with very low complication rates. Failure of the procedure did not exceed 4 %. Therefore, intraparotid SLNB may be superior to an extensive surgery such as SP and should be examined in future prospective trials.