Limited or selective nodal dissection for malignant melanoma of the head and neck

Fifty-eight patients with invasive melanoma of the head and neck underwent regional nodal dissections by one surgeon from 1971 to 1981. Types of nodal dissections employed were radical neck dissection and modified radical neck dissection, alone or in combination, with selective nodal dissection of the parotid, jugular, suprahyoid posterior neck, or posterior triangle lymph node groups. Patients undergoing secondary nodal dissections had early recurrence (9 months versus 30 months) and earlier times of death (26 months versus 41 months). There was no demonstrable difference in morbidity, mortality, or rate of recurrence based on type of nodal dissection. There were no regional failures after selective nodal dissection alone when the nodes removed were negative. This limited study suggests that selective nodal dissection, alone or in conjunction with radical neck dissection or modified radical neck dissection, depending on the location and measurements of the primary lesion, allows accurate pathologic staging and apparent control of local disease with minimal morbidity. Longer follow-up and greater numbers are necessary for valid conclusions.