Support for sentinel lymph node biopsy of periocular tumors

The authors present a retrospective case series of five patients with extensive periocular invasive squamous cell carcinoma (SCC) who had positive sentinel lymph node biopsies (SLNB) in the absence of other evidence of metastatic disease. SLNB was well tolerated and uncovered regional metastasis, and the findings influenced subsequent oncologic management recommendations. While the study provides support for the use of SLNB in the management of periocular tumors, the usefulness of SLNB for poorly differentiated SCC remains uncertain.

The patients all had large (2.0 to 4.3 cm) primary tumors with poor differentiation on pathology. While tumor cells may drain to the preauricular or the submandibular basin, the preauricular lymph node was identified as the sentinel lymph node on lymphoscintigraphy in all five patients.

The positive sentinel lymph nodes changed the staging of the disease in each patient and subsequently impacted the treatment of three patients who underwent a combination further surgery, adjuvant chemotherapy and radiation. Two patients refused further therapy.

The researchers identified no complications related to SLNB, including facial nerve damage, lymphedema or allergic reaction to radioactive tracing material.

They say that SLNB may uncover regional metastasis not apparent on clinical evaluation or imaging. However, further research is necessary to establish the role of SLNB in periocular SCC.