The chart of 56 patients, consecutively operated on in our institution for
malignant melanoma of the skin in the head and neck area from 1977 to 1993,
were retrospectively reviewed. The follow-up was 2 to 18 years (average 7.
5 years). We considered three kinds of treatment, looking at the adequacy a
nd timing of surgery: (1) Planned definitive surgery (PDS), when surgery wi
th adequate margins and lymph node dissection was done within two months af
ter the initial diagnosis; (2) non-planned definitive surgery (non-PDS), wh
en at least one of the above parameters could not be achieved; (3) and salv
age surgery (Ss), for patients who presented with local recurrence or invol
ved lymph nodes. Twenty-four patients were in the first group, ten in the s
econd, and 22 in the third. Elective neck dissection was performed in 16 pa
tients with a superficial spreading melanoma (SSM) or nodular melanoma (NM)
lesion thicker than 1 mm, and a therapeutic radical neck dissection in 17
patients with a suspicious lymph node occurring at any stage of the disease
. According to the type of surgical management, the five year survival was
90%, 60%, and 25% for PDS, non-PDS, and Ss groups, respectively (p<0.01), P
atients who were initially treated with elective lymph node dissection had
better prognosis than those who had therapeutic lymph node dissection (88%
versus 19% at 8 years, p<0.001). These results further support the benefit
of planned surgical treatment, i.e. within two months, for malignant melano
ma of the head and neck.