Experience with 998 cutaneous melanomas of the head and neck over 30 years

Article Abstract:

One of the most common cancers in Australia is cutaneous melanoma. Cutaneous melanoma is a malignant tumor of the skin, which contains melanocytes (cells that produce melanin, the black or brown pigment that occurs naturally in the skin, hair and iris of the eye). In Australia, melanoma is the fourth most common cancer among men (after lung, prostate, and colon cancer) and the third most common among women (after breast and colon cancer). This reflects the influence of a high level sun exposure in a population descended mainly from Anglo-Saxons and Celts (fair skinned people). Main treatment for melanoma is surgery. Most deaths are due to spread of the cancer (metastasis), even if control of cancer at the original site is effective. Melanomas of the head and neck are difficult to treat because excision is often limited by considerations of anatomy, appearance, and function of the involved area. The overall effectiveness of surgery was evaluated in a study that reviewed 998 patients treated for skin melanoma at the Sydney Melanoma Unit. The average patient age was 53, and the most common sites were the face (47 percent), neck (29 percent), scalp (14 percent), and the ear (10 percent). All patients had surgery. There were 152 patients who had therapeutic neck dissection and 234 who had elective neck dissection. Neck dissection involves removal of all the lymph nodes from the jaw to collar bone, and may result in reduction of shoulder function and in facial swelling. The rate of local recurrence was 13 percent. Survival (specific to melanoma) at five years was 77 percent; at 10 years, survival was 66 percent. Survival varied significantly with age, tumor thickness, ulceration, site, cancer spread to lymph nodes, and distant metastasis. Univariate analysis showed that elective removal of lymph nodes seemed to improve survival; however, this benefit was lost when multivariate analysis was performed. The diagnosis of lentigo maligna melanoma (noninvasive malignant melanotic freckle) was associated with better survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Australia, Usage, Demographic aspects, Melanoma, Radical neck dissection

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Metastatic adenocarcinoma to the neck from an unknown primary course

Article Abstract:

Spread of cancer (metastasis) to the lymph nodes in the neck and head, without a known site of origin, is unusual. Most (85 percent) cancers in which the primary site is unknown are adenocarcinomas. A retrospective review is presented of patients treated between 1970 and 1987 for metastatic adenocarcinoma. The metastasis was in the lymph nodes of the head and neck but the primary cancer site was unknown. The medical records of 223 patients were reviewed, and survivors were followed for at least two years. Patients ranged in age from 16 to 85 (average 55); 52 percent were male. The most common site was the supraclavicular fossa (depression on either side of the neck behind the collar bone), accounting for 76 percent of the cases. Fourteen percent of patients had bilateral disease. Metastasis to other parts of the body was present in 86 percent of patients, the most common sites were the breast bone (35 percent), the lung (21 percent), and other bones (19 percent). At the end of the study, there were 17 patients surviving (7.6 percent); all had no evidence of disease. The average survival time was 17 months, but only half of the patients survived eight months. At two years, the survival rate was 20 percent, and at five years, it was 9 percent. Increased survival was associated with involvement of only one side of the neck, and with disease that was limited to the nodes above the cricoid cartilage in the upper neck, at the level of the sixth cervical vertebra. An algorithm for evaluating and treating patients is discussed. If other metastasis is not evident, maximum treatment should be directed toward the neck cancer. Some treatment approaches are briefly discussed, but no treatment that has achieved a high response rate has yet been found. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Metastasis, Cancer metastasis

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