[Cutaneous malignant melanoma in the area of the head and neck with intermediate tumor thickness: does primary site have prognostic relevance?].

BACKGROUND

Tumor thickness and infiltration of malignant melanoma are the main prognostic factors for recurrence and survival. The sentinel lymph node biopsy may provide a step toward a more individual staging and therapy. It 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 case of intermediate tumor thickness metastatic pattern of the different primary 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 were 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 metastases could be demonstrated in unusual sites by skipping the first draining basin. In three cases bilateral metastases could be shown histologically as opposed to clinical prediction.

CONCLUSIONS

Localization of cutaneous malignant melanoma of the head and neck is a prognostic factor for survival. Because of the discordancy between clinical prediction and lymphatic drainage pattern sentinel lymph node biopsy improves accuracy of diagnostic and therapeutic procedures.