Zitsch R P, Roberts G D, Smith R B
Department of Surgery, University of Missouri Hospital and Clinics, MO, USA.
Otolaryngol Head Neck Surg. 1999 Mar;120(3):391-3. doi: 10.1016/S0194-5998(99)70281-0.
Recurrent cutaneous melanoma is generally regarded as having an extremely poor prognosis, particularly when regional lymph nodes are involved. A few reports have documented long-term survival among those patients treated for regionally recurrent melanoma.
This article reviews patients at our institution undergoing complete neck dissection for recurrent head and neck melanoma.
Twenty-six patients with locoregionally recurrent cutaneous melanoma of the head and neck underwent complete neck dissection with or without parotidectomy. Seventeen of these procedures were for clinically evident cervical lymphadenopathy, whereas 9 of the neck dissections were done electively. Fourteen of the 17 patients with clinical adenopathy were confirmed to have cervical lymph node metastases. Two of the 9 patients who underwent elective neck dissections had pathologic lymph nodes. At 5 years, 38% of the patients with isolated neck recurrences not also having concurrent primary site recurrence were alive without disease.
These results provide further evidence suggesting a benefit in the form of long-term survival or cure for patients receiving aggressive surgical treatment for resectable recurrent head and neck melanoma involving cervical lymphatics in the absence of distant metastases.
复发性皮肤黑色素瘤通常被认为预后极差，尤其是当区域淋巴结受累时。少数报告记录了那些接受区域复发性黑色素瘤治疗的患者的长期生存情况。
本文回顾了在我们机构接受根治性颈部清扫术治疗复发性头颈部黑色素瘤的患者。
26例头颈部局部复发性皮肤黑色素瘤患者接受了根治性颈部清扫术，部分患者还接受了腮腺切除术。其中17例手术针对临床明显的颈部淋巴结病，而9例颈部清扫术为选择性进行。17例临床有淋巴结病的患者中有14例被证实有颈部淋巴结转移。9例接受选择性颈部清扫术的患者中有2例有病理证实的淋巴结转移。5年时，孤立性颈部复发且无原发部位同时复发的患者中有38%存活且无疾病。
这些结果提供了进一步的证据，表明对于可切除的、复发性头颈部黑色素瘤累及颈部淋巴管且无远处转移的患者，积极的手术治疗可带来长期生存或治愈的益处。
