Cutaneous malignant melanoma of the head and neck with intermediate tumor thickness: Localization of the primary tumor is a prognostic factor.

Background: Tumor thickness and infiltration of malignant melanoma are the main prognostic factors for recurrence and survival. The sentinel lymph nod e biopsy may provide a step toward a more individual staging and therapy. I t was the aim of this study to investigate the prognostic influence of the primary localization of head and neck melanoma subdivided into scalp, ear, neck, and face. To form a basis for routine sentinel lymph node biopsy in c ase of intermediate tumor thickness metastatic pattern of the different pri mary sites were analysed. Method: Survival rates depending on primary tumor site of 51 patients with cutaneous malignant melanoma of the head and neck were analysed. Metastatic pattern were evaluated with the help of clinical , intraoperative, pathohistologic data. Results: Scalp and ear melanoma wer e found to be higher risk lesions with a 5-year survival rate of 28% and 59 % respectively. Melanoma of the neck and face had a 5-year survival rate of 75% and 78% respectively. In two cases of ear melanoma lymph node metastas es could be demonstrated in unusual sites by skipping the first draining ba sin. In three cases bilateral metastases could be shown histologically as o pposed to clinical prediction. Conclusions: Localization of cutaneous malig nant melanoma of the head and neck is a prognostic factor for survival. Bec ause of the discordancy between clinical prediction and lymphatic drainage pattern sentinel lymph node biopsy improves accuracy of diagnostic and ther apeutic procedures.