Cutaneous melanoma of the head and neck.

Melanoma of the head and neck, if diagnosed early and treated with aggressive appropriate surgical therapy, is potentially curable in up to 80 to 90 per cent of the cases. The use of microscopic staging by level of invasion and thickness of the tumor is helpful in determining the appropriate surgical procedure for the individual patient and is of prognostic significance. If possible, prophylactic incontinuity regional node dissection should be performed for melanomas of the head and neck that have invaded to Level III or deeper, especially those that are greater than 1.5 mm in thickness. The histological status of the regional nodes is beneficial both therapeutically and prognostically, in that patients who have negative nodes have a better prognosis than those with microscopically positive nodes. Also, these patients with microscopically positive nodes have a much better survival than those with macroscopically positive nodes. Melanoma of the head and neck should be treated very aggressively with wide excision of the primary tumor in order to prevent local recurrence and further spread of the disease. Since surgical treatment is the only effective curative measure for melanoma, all localized tumor in the region of the primary and solitary distant metastasis should be removed if possible. The adjunctive use of chemotherapy and immunotherapy when regional nodes are involved with melanoma is being studied and may be of some benefit. The combinations of surgical therapy, chemotherapy, immunotherapy, and radiotherapy offers the patient with advanced disease significant palliation, sometimes for prolonged periods. The treatment of head and neck melanoma is best summarized by the statement in the December 4, 1965 of The Lancet.-.29 "The surgeon who first operates on a malignant melanoma has a great responsibility. Prompt and competent action will give the patient a chance of survival better than in most other forms of cancer. The only additional operative surgical skill required is the ability to cut and apply split skin grafts. If he lacks confidence therein, let the surgeon refer the case at once and certainly before he has ruined, by niggling interference, the patient's chance of survival."