Fisher S R, Reintgen D S, Seigler H F
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Laryngoscope. 1988 Feb;98(2):184-9. doi: 10.1288/00005537-198802000-00013.
Malignant melanoma of the head and neck is a potentially lethal disease and considered rare among juveniles. Treatment patterns have historically been dictated by experience with adults, however a paucity of data is available to determine the natural history and treatment guidelines for juveniles and children with malignant melanoma. Therefore a retrospective computer-aided analysis of patients less than 20 years of age having malignant melanoma were obtained from the records of 4,843 patients with malignant melanoma recorded from 1972 through 1986. Eighty-seven patients were identified from this group with 17 patients having primary malignant melanomas confined to the head and neck. Parameters evaluated were age at diagnosis, sex, type of melanoma, Clark Level, Breslow depth of invasion, pathologic classification, site of primary, nodal status at diagnosis, surgical treatment, recurrence rate and site of recurrence, and follow-up status. Two of 17 patients had stage II disease and were treated with wide local excision and therapeutic radical neck dissection. Fifteen of 17 patients initially presented with stage I disease were treated with wide local excision. Two of these patients underwent elective radical neck dissection both of which proved to have positive occult nodal disease. Both are alive without evidence of disease 2 1/2 to 7 years later. Of the 13 patients who were initially treated with only wide local excision, nine patients developed local (3), regional (3), or systemic (3) disease within 3 months to 9 years from the date of diagnosis. Seven of the nine died of their disease 5 months to 20 years later. When juvenile patients with melanomas of the head and neck are compared to a comparable age group of patients with melanomas at other primary body sites, the head and neck group had a significantly higher frequency of death. Compared to the adult head and neck population, juvenile patients had identical actuarial survival time, but shorter disease-free intervals, even though the adult population had a higher percent of poor prognostic indices (presence of ulceration and thickness of lesions). Failure to control local and regional disease coupled with the overall poor survival rate, indicates that malignant melanoma occurs in the young as a biologically active tumor and suggests an aggressive approach for better control of local and regional disease and, hopefully, survival.
头颈部恶性黑色素瘤是一种潜在的致命疾病，在青少年中较为罕见。以往的治疗模式一直受成人治疗经验的支配，然而，目前缺乏数据来确定青少年和儿童恶性黑色素瘤的自然病程和治疗指南。因此，我们从1972年至1986年记录的4843例恶性黑色素瘤患者的病历中，对年龄小于20岁的恶性黑色素瘤患者进行了回顾性计算机辅助分析。从该组中确定了87例患者，其中17例原发性恶性黑色素瘤局限于头颈部。评估的参数包括诊断时的年龄、性别、黑色素瘤类型、克拉克分级、布雷斯洛浸润深度、病理分类、原发部位、诊断时的淋巴结状态、手术治疗、复发率和复发部位以及随访状态。17例患者中有2例为II期疾病，接受了广泛局部切除和根治性颈部治疗性清扫术。17例最初表现为I期疾病的患者中有15例接受了广泛局部切除。其中2例患者接受了选择性根治性颈部清扫术，结果均显示有隐匿性淋巴结转移阳性。两人在2年半至7年后均存活且无疾病迹象。在最初仅接受广泛局部切除治疗的13例患者中，9例患者在诊断后3个月至9年内出现局部（3例）、区域（3例）或全身（3例）疾病。9例患者中有7例在5个月至20年后死于该病。将头颈部黑色素瘤的青少年患者与其他身体原发部位黑色素瘤的同龄患者组进行比较时，头颈部组的死亡频率明显更高。与成年头颈部人群相比，青少年患者的精算生存时间相同，但无病间期较短，尽管成年人群中预后不良指标（溃疡的存在和病变厚度）的比例较高。未能控制局部和区域疾病以及总体较差的生存率表明，恶性黑色素瘤在年轻人中表现为一种生物学上活跃的肿瘤，这提示需要采取积极的方法来更好地控制局部和区域疾病，并有望提高生存率。
