Sentinel Lymph Node Biopsy in Head and Neck Merkel Cell Carcinoma: Why High False-Negative Rates Demand Clinical Vigilance

Highlights

• Sentinel lymph node biopsy (SLNB) in head and neck Merkel cell carcinoma (MCC) demonstrates a sensitivity of only 52.6%, significantly lower than in other cutaneous malignancies.
• The procedure failed in 29.0% of cases, with failure significantly associated with tumor location, female sex, and advanced age.
• Lymphovascular invasion (LVI), infiltrative growth patterns, and tumor size are the strongest predictors of occult nodal disease.
• Negative or failed SLNB results in this region may require intensified surveillance or adjuvant therapy due to a false-negative rate of 26.7%.

Background: The Challenge of Merkel Cell Carcinoma in the Head and Neck