Recommendations for therapy of head and neck cutaneous melanoma

The essential element in the treatment of a primary cutaneous malignant melanoma is an adequate definitive excision. The breadth and depth of such excisions and the appropriateness of a prophylactic neck dissection, however, remain a source of controversy.

A review of our experiences with 500 patients with head and neck malignant melanoma treated in our clinic between 1967 and 1987 is presented.

The thickness of the lesion, the factor that correlated most closely with potential for metastatic development, can be used as a guide for determining the extent of excision and the appropriateness of elective node dissection. Wide excision of invasive lesions varies in their margins from 1 cm for lesions that measure less than .75 mm in thickness to 3 cm if the melanomas measure greater than .75 mm or show ulcerations or have a scalp localization. Prophylactic neck dissection is necessary for lesions between .75 and 1.5 mm in thickness, whereas in tumors with a depth of invasion greater than 1.5 mm the outcome of the disease is not improved by prophylactic neck dissection.