Prise en charge ganglionnaire des mélanomes de la tête et du cou : étude rétrospective de 25 cas

Abstract

Twenty percent of melanoma are located on the head and neck. The treatment of advanced melanoma is still a controversial question. The aim of this study was to analyze the results of lymph node treatment in melanoma, and to try to determine guidelines for management. Sixteen male and 9 female patients (mean age 57.1 years) presenting with head and neck melanoma with parotid or cervical node involvement were treated by curative surgery. Most tumors were classified intermediate according to the Breslow thickness. The average of nodes involved was 2.3 with 44% of cases presenting with capsular rupture. The mean follow-up was 32 months. The mean delay of recurrence was 18.2 months. The 5-year probability of survival was 49.7% and the one none-recurrence was 15.8%. Patients without capsular rupture had a better prognosis (P=0.04). The management of advanced melanoma of the head and neck is still controversial, but: 1-worse prognosis of patients with advanced melanoma; 2-percentage of occult metastasis was about 20; 3-better prognosis for patients with palpable nodes who had neck dissection and postoperative radiation in cases of node involvement. Until the sentinel node technique becomes widely accepted and performed we recommend: prophylactic dissection (cervical or parotidectomy) in patients with intermediate thickness and without palpable nodes; when patients have resectable node involvement a postoperative radiotherapy.