What is the role of neck dissection in the treatment of cutaneous malignancies?

Updated: Aug 19, 2020
  • Author: Ron Mitzner, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Selective neck dissection (II-V, postauricular, suboccipital) was initially described as a posterolateral neck dissection by Rochlin in 1962 and later modified and popularized by Geopfert et al for use in patients with cutaneous malignancies of the scalp and postauricular and suboccipital regions as depicted below. Unlike all other neck dissections, this operation is performed with the patient in the lateral decubitus position and consists of an en bloc removal of the lymph nodes in the suboccipital; postauricular; and upper, middle, and lower jugular nodes, along with posterior triangle nodes situated superior to the accessory nerve. See the image below.

Selective neck dissection for posterior scalp and Selective neck dissection for posterior scalp and upper posterolateral neck cutaneous malignancies: selective neck dissection II-V, postauricular, suboccipital, or posterolateral neck dissection.

Although the original description included sacrifice of the accessory nerve, internal jugular vein, and a portion of the trapezius muscle, Diaz et al from the MD Anderson Cancer Center showed in 1996 that the preservation of these nonlymphatic structures does not increase the failure rate of this operation. [24] Any variation of this operation involves naming the level of nodes removed. In cancers that arise in the preauricular, anterior scalp, or temporal region, the elective neck dissection of choice is selective neck dissection (II, III, Va, parotid, facial, external jugular nodes).


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