Franklin J D, Reynolds V H, Bowers D G, Lynch J B
Clin Plast Surg. 1976 Jul;3(3):413-27.
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."
头颈部黑色素瘤，如果早期诊断并采用积极适当的手术治疗，高达80%至90%的病例有可能治愈。根据肿瘤的浸润深度和厚度进行微观分期，有助于为个体患者确定合适的手术方案，且具有预后意义。对于已侵犯至Ⅲ级或更深层次的头颈部黑色素瘤，尤其是厚度大于1.5mm的黑色素瘤，如有可能应进行预防性连续性区域淋巴结清扫。区域淋巴结的组织学状态在治疗和预后方面均有益，因为淋巴结阴性的患者比显微镜下淋巴结阳性的患者预后更好。此外，这些显微镜下淋巴结阳性的患者比肉眼可见淋巴结阳性的患者生存率要高得多。头颈部黑色素瘤应积极进行广泛切除原发肿瘤的治疗，以防止疾病局部复发和进一步扩散。由于手术治疗是黑色素瘤唯一有效的治愈措施，如有可能应切除原发部位和孤立远处转移灶区域的所有局限性肿瘤。当区域淋巴结受累时，化疗和免疫治疗的辅助应用正在研究中，可能会有一定益处。手术治疗、化疗、免疫治疗和放疗的联合应用可为晚期患者带来显著的缓解，有时可持续较长时间。1965年12月4日《柳叶刀》杂志的一篇文章对头颈部黑色素瘤的治疗做了最好的总结：“第一位对恶性黑色素瘤进行手术的外科医生肩负着重大责任。迅速而恰当的行动将给患者带来比大多数其他癌症更好的生存机会。唯一额外需要的手术技能是切割和应用中厚皮片移植的能力。如果他对此缺乏信心，外科医生应立即转诊该病例，当然要在他因琐碎的干预而毁掉患者生存机会之前。”
