Kane W J, Yugueros P, Clay R P, Woods J E
Department of Surgery, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minnesota 55906, USA.
Head Neck. 1997 Sep;19(6):457-65. doi: 10.1002/(sici)1097-0347(199709)19:6<457::aid-hed1>3.0.co;2-y.
Cutaneous malignant melanoma (CMM) is increasing in frequency. Surgery remains the primary and only curative treatment method. Our aim was to define prognostic factors and outcome predictors for patients with clinical stage I CMM of the head and neck.
Surgical treatment and outcome was analyzed for 424 patients with clinical stage I melanoma of the head and neck, completing initial treatment at the Mayo Clinic (1970-1990). The data were analyzed using the Kaplan-Meier product-limit method and Cox multiple-regression models.
Overall, 180 (42%) patients underwent elective lymph node dissection (ELND) as part of the initial treatment; occult disease was demonstrated in 15 (8.3%). Among patients with tumor > 1.5 mm thick, occult regional disease was found in 15%. Failure of final treatment occurred in 152 (36%). Overall, 82% and 75% of the patients survived 5 and 10 years, respectively.
Tumor thickness, extent of invasion, and the presence of occult region metastatic disease were the only independently predictive value (p < .005) of recurrence. The detection of disease by ELND did not appear to protect the patient from disease progression but identified those with regionally advanced disease and highest risk for recurrence. The development of recurrence significantly reduced but did not eliminate the potential for extended disease-free survival with subsequent treatment.
