[Surgical treatment possibilities of malignant melanomas in the head and neck region]

The surgical approach in malignant melanoma of the head and neck region still depends on the clinical assessment of the disease, since the decisive prognostic data - depth of invasion and histological proof of the diagnosis are not available preoperatively. Frozen section examination has a 12-15% failure rate, the incidence of clinically erroneous diagnosis being about 15-20%. Consequently, the first step in treatment is still an extensive excisional biopsy, although the dimensions of the excision in the head and neck region may be smaller than in other regions of the body to take account of functionally important tissues. A radical neck dissection should be performed if the depth of the primary tumor is greater than 0.75 mm and less than 4 mm. Malignant melanomas less than 0.75 mm deep will rarely metastasise. In case of a malignant melanoma with more than 4 mm depth of invasion, neck dissection cannot improve the already poor prognosis because of the high incidence of hematogenous metastases.