[Malignant melanoma in the area of the head and neck]

The incidence of malignant melanoma is rising worldwide. Recognition of the biological types of malignant melanoma (nodular melanoma, superficial spreading melanoma, lentigo maligna melanoma, and acrolentiginous melanoma) have greatly helped to improve the prognosis in recent years. Determination of the depth of invasion in histological serial sections has proved to be of great prognostic value. Melanomas with minimal invasion have an excellent prognosis. Wide excision of the primary tumour is of utmost importance. The excisional margins should be 3-5 cm, but in superficial melanomas the width of excision may be less. Prophylactic neck dissection is unnecessary for superficial melanomas, it is necessary for lesions between 1 and 3.9 mm in thickness, whereas in tumours with a depth of invasion greater than 4 mm the outcome of the disease is not improved by prophylactic neck dissection. In metastasizing malignant melanoma the tumour mass should be reduced by surgical intervention. Survival is sometimes prolonged by several months or even longer when lymph nodes and metastases are excised. A radical neck dissection is indicated therefore when lymph nodes are clinically involved.