Regional lymph node management and outcome in 100 patients with head and neck melanoma.

One hundred patients with invasive melanoma of the head and neck were treated by one surgeon from 1970 to 1978. Lymph node dissections were performed in 77 patients for palpable adenopathy, local recurrence, or tumor thickness greater than 0.75 mm when measured by micrometry. No patient whose lesion was less than 1.0 mm thick had a local recurrence or died as a result of melanoma. Patients who underwent elective lymph node dissection with findings of up to two positive nodes had a 53 to 56 percent 5 year survival rate, while those with three or more nodes had a poor prognosis (15 percent 5 year survival rate). The patterns of recurrence showed that relapse after nodal dissection usually presented with systemic metastases. The data support a therapeutic scheme based on 2 to 5 cm wide excision alone for lesions less than 0.75 mm in thickness and elective nodal dissection for specific indications.