TREATMENT OUTCOME FOR 424 PRIMARY CASES OF CLINICAL STAGE-I CUTANEOUSMALIGNANT-MELANOMA OF THE HEAD AND NECK

Background. Cutaneous malignant melanoma (CMM) is increasing in freque ncy. Surgery remains the primary and only curative treatment method. O ur aim was to define prognostic factors and outcome predictors for pat ients with clinical stage I CMM of the head and neck. Methods. Surgica l treatment and outcome was analyzed for 424 patients with clinical st age I melanoma of the head and neck, completing initial treatment at t he Mayo Clinic (1970-1990). The data were analyzed using the Kaplan-Me ier product-limit method and Cox multiple-regression models. Results. Overall, 180 (42%) patients underwent elective lymph node dissection ( ELND) as part of the initial treatment; occult disease was demonstrate d in 15 (8.3%). Among patients with tumor > 1.5 mm thick, occult regio nal disease was found in 15%. Failure of initial treatment occurred in 152 (36%). Overall, 82% and 75% of patients survived 5 and 10 years, respectively. Conclusions. Tumor thickness, extent of invasion, and th e presence of occult regional metastatic disease were the only indepen dently predictive value (p < .005) of recurrence. The detection of dis ease by ELND did not appear to protect the patient from disease progre ssion but identified those with regionally advanced disease and highes t risk for recurrence. The development of recurrence significantly red uced but did not eliminate the potential for extended disease-free sur vival with subsequent treatment. (C) 1997 John Wiley & Sons, Inc.