Management of complex melanomas of head and neck region

Though many of the melanomas encountered in the head and neck region are amenable to simple excision and direct closure or skin grafts, there is a subset of patients who are deemed complex cases in view of the large size of the tumour, depth of invasion or proximity to aesthetically and functionally important structures. This was a retrospective study which looked at complex melanomas of the head and neck region treated in the last 10 years. There were a total of 19 cases, including four women and 15 men. Their ages ranged from 59 to 83 years (mean: 69 years). The Breslow thickness of these tumours ranged from 1 to 40 mm, with an average of 9 mm. The resectional procedures used herein included wide local excision (15 patients), wide excision with partial maxillectomy (one patient), wide excision with total maxillectomy (one patient) and orbital exenteration (two patients). Neck dissections were performed in 12 cases and parotidectomy was performed in five cases. Reconstruction was performed using local (two cases), regional (five cases) and free flaps (11 cases) in a total of 18 cases. There were four complications, including two nerve injuries during neck dissection (vagus and marginal mandibular nerve). Four patients died during follow-up due to metastatic disease and had a median survival of 3.5 years (range: 2-8 years, mean: 3 years). One patient is alive with recurrent disease and distant metastases 4 years after the original surgery. The remaining 14 patients are alive and free of recurrence with a follow-up period ranging from 2 to 7 years (median: 4.5 years).