Radiotherapy in nonlentiginous melanoma of the head and neck

Thirty-seven patients with superficial spreading or nodular melanoma of the head and neck treated with irradiation are reviewed. Twenty-one patients were referred within three months of surgery. Six had an incisional biopsy followed by postoperative irradiation, 4 were locally controlled (1 dying of metastatic melanoma, 2 dying of intercurrent disease and 1 is alive and well), and 2 were not (both dead of melanoma). Fifteen patients had a local excisional biopsy (11 having tumor to the limits of the excision) followed by postoperative irradiation. Fourteen of the 15 had local control (3 had lymph node metastases and died, 3 died of distant metastases from melanoma, 7 are alive and well from 1-14 years following treatment, and one is dead of intercurrent disease), and 1 had a local recurrence and subsequently died of metastatic melanoma. Sixteen patients were irradiated for local and/or regionally recurrent disease following unsuccessful surgery, and only two were successfully controlled by irradiation and are alive and well at four and five years, respectively. Local control was 70% when a dose per fraction of greater than 400 rads was used, compared with 25% when a dose per fraction of less than 400 rads was used. It is concluded that nonlentiginous melanoma of the head and neck is not a radioresistant tumor and that local excision followed by high dose per fraction radiotherapy deserves further study in the management of melanomas of the head and neck.