RECOMMENDATIONS FOR THERAPY OF HEAD AND NECK CUTANEOUS MELANOMA

Purpose: The essential element in the treatment of a primary cutaneous malignant melanoma is an adequate definitive excision. The breadth and depth of such excisions and the appropriateness of a prophylactic neck dissection, however, remain a source of controversy. Method: A review of our experiences with 500 patients with head and neck malignant melanoma treated in our clinic between 1967 and 1987 is presented. Results and Conclusions: The thickness of the lesion, the factor that correlated most closely with potential for metastatic development, can be used as a guide for determining the extent of excision and the appropriateness of elective node dissection. Wide excision of invasive lesions varies in their margins from 1 cm for lesions that measure less than .75 mm in thickness to 3 cm if the melanomas measure greater than .75 mm or show ulcerations or have a scalp localization. Prophylactic neck dissection is necessary for lesions between .75 and 1.5 mm in thickness, whereas in tumors with a depth of invasion greater than 1.5 mm the outcome of the disease is not improved by prophylactic neck dissection. © 1993.