Primary malignant mucosal melanoma of the head and neck

Primary malignant melanoma of the head and neck is an uncommon disease associated with a very poor prognosis, and an unpredictable natural disease process. Most patients, when diagnosed, pose a major dilemma to their treating clinicians as to what is the most appropriate current management options available with their likely short-term or long-term results.

Not much new has been reported in terms of aetiology and biology. There have been proposals for improvements in staging disease at presentation, so as to permit better analysis of results. Surgery continues to be advocated as the treatment option of choice. The role of radiotherapy as primary management of mucosal malignant melanoma remains controversial, but its use following surgery does seem to achieve local tumour control and patient survival. The use of chemotherapy or immunotherapy in mucosal malignant melanoma continues to lack structure and a role. Patients presenting with mucosal malignant melanoma should be registered and entered into a national or even international randomized controlled trial, which includes surgery, radiotherapy and immunotherapy.

Primary malignant mucosal melanoma of the head and neck is rare. The current standard of treatment remains surgery with postoperative radiotherapy. Such treatment aims at local disease control, with close follow-up observation and salvage treatment for local, regional and disseminated disease if it occurs. Salvage treatments are rare and uncommon, and most do not result in any significant additional patient survival. The role of chemotherapy and immunotherapy remains speculative unless patients are entered into some form of randomized controlled trials.