The posterolateral neck dissection is an operation that is typically used in the management of cutaneous cancers of the posterior scalp, auricle, or upper neck either electively to stage the clinically node-negative neck or therapeutically to treat the node-positive neck. In contemporary practice, this operation is most often used to treat a clinically node-negative neck that has been found to have microscopically positive nodal disease in one or more of the regional nodal basins. While a description of this operation was first published in 1962, Drs. Goepfert, Jesse, and Ballantyne of the MD Anderson Cancer Center wrote a definitive description of this procedure and their results with it in 1980. Typically, this operation involves the removal of the lymph nodes in the postauricular, suboccipital, spinal accessory and the jugular lymph node basins (Fig. 8.1). In experienced hands, this operation provides excellent oncologic, functional, and cosmetic results.

Visual evaluation and palpation of the extent of the primary tumor and nodal metastasis are traditionally part of the initial assessment of the patient for whom posterolateral neck dissection is being considered. This includes inspection of the scalp, auricle, and neck and palpation of the entire neck with particular attention to the post-auricular, suboccipital, spinal accessory and jugular nodal basins. The number and size of each involved node should be recorded and used as part of the clinical staging. Previous surgery in this area should be noted.

This operation is contraindicated in patients for whom the procedure would neither prolong survival nor provide significant palliation. This may include patients with disseminated metastatic cancer. Additionally, those patients with extensive lymph node metastasis with involvement of the deep muscles of the neck, vertebrae, or carotid artery are advised to consider systemic therapy options that could help decrease the risk of distantly metastatic disease and potentially make the local-regional disease burden more manageable by resection. Patients deemed to be medically high risk for general anesthesia, who have microscopic nodal disease, can often be managed successfully with radiation therapy alone.