Management of primary cutaneous melanoma of the head and neck: The University of Colorado experience and a review of the literature

Background: While elective lymph node dissection (ELND), adjuvant radiation therapy and sentinel lymph node biopsy have all been advocated in the rout ine management of primary cutaneous melanoma arising in the head and neck, the optimal management has not been defined. Methods: We have reviewed our experience of 273 patients with primary melan oma of the head and neck entered into a prospective database at the Univers ity of Colorado Health Sciences Center (UCHSC) from 1978 through 1998 and c ontrasted this with other reports in the literature. Results: A total of 168 patients were identified that received their initia l management at UCHSC and had no clinical evidence of distant disease. Only nine patients (5%) underwent ELND, and no patients received adjuvant radia tion therapy. The local recurrence rate and 5-year melanoma specific surviv al, according to Breslow thickness, were similar to centers where adjuvant radiation therapy or ELND are routinely performed. Our preliminary experien ce and a review of the literature suggests that the technique of sentinel l ymph node biopsy is an accurate and low risk procedure that provides valuab le prognostic information useful in the further management of these patient s. Conclusions: There is no clear indication that either ELND or adjuvant radi ation therapy impacts on the outcome of patients with primary melanoma of t he head and neck. Sentinel lymph node biopsy, in appropriate cases, is beco ming the standard of care. (C) 2001 Wiley-Liss, Inc.