Predicting SLNB Positivity in Head and Neck Melanoma: A Nomogram and Online Risk Tool

ABSTRACT Objectives Sentinel lymph node biopsy (SLNB) is the standard staging procedure in cutaneous melanoma of the head and neck, but current guidelines are extrapolated from non–head and neck studies. Existing risk models lack specificity for this region. Using the National Cancer Database, we developed and internally validated a nomogram and web‐based calculator to estimate SLNB positivity specifically in head and neck cutaneous melanoma. Methods We conducted a retrospective cohort study using the NCDB, including patients with cutaneous melanoma of the head and neck. The inclusion criteria were patients with clinical node‐negative, early‐stage melanoma who underwent SLNB between 2004 and 2021. Demographic, clinical, and pathologic features were compared using chi‐squared testing, and multivariable logistic regression identified independent predictors of SLNB positivity. Significant factors were incorporated into a nomogram and interactive risk calculator. Results We included 14,058 clinical N0, M0 cutaneous head and neck melanoma patients who underwent SLNB. Of these, 2182 (15.5%) had a positive SLNB. In multivariable analysis, age, head and neck sublocation, histologic subtype, mitotic rate, Breslow thickness, lymphovascular invasion, and ulceration were identified as independent predictors of SLNB positivity. A nomogram based on these variables was developed. The model demonstrated good discrimination with a C‐index of 0.724 (95% CI, 0.712–0.735). Conclusions This study provides a predictive tool that allows head and neck surgeons to estimate the risk of SLNB positivity in individual patients, enabling more personalized surgical decision‐making in early‐stage head and neck melanoma. Level of Evidence 3.