Melanoma of the head and neck in Queensland

The incidence of melanoma in Queensland, 40 cases per 100,000 population, is the highest in the world. In this series of 740 melanomas over a 7-year period at the Royal Brisbane Hospital, 21.75% occurred on the head and neck. Of these, 46.5% arose in Hutchinson's melanotic freckle and 54.8% were histologically superficial, that is, Clark Levels I and II or less than 0.76 mm in thickness, or both. As local recurrence and distant metastasis is infrequent in superficial melanoma, less radical surgical excision of these lesions is advocated than for thicker lesions or those exhibiting a greater depth of invasion, where aggressive excision and even regional node dissection may be required. Anatomical variations in areas such as the nose, eyelid, ear, and scalp influence patterns of spread and necessitate differences in treatment at each site.