文档介绍：Surgery of Melanoma of the Head and Neck
Jeffery N. Myers, MD, PhD,1 and Hernan E. Gonzalez, MD, PhD2
utaneous malignant melanoma (CMM) is an aggres- face, we mend at least a 1-cm margin. For interme-
Csive malignancy with an incidence rate that is in- diate thickness melanomas of the scalp and neck, the
creasing by 5% each year. In about 30% of patients with extent of the resection can be increased to 2 cm, particu-
CMM, the primary site is located in the head and neck. larly if there are adverse features such as ulceration or
The surgical management of CMM of the head and neck, satellite lesions. For lesions greater than 4 mm, we favor
as for other locations, is aimed to achieve disease control, 2-cm margins. For the depth of resection of thin lesions,
both at the primary site and of the regional lymphatics. we include a deep margin of subcutaneous tissue. For
Therefore, detailed knowledge of factors that determine intermediate thickness lesions, depending on the loca-
biologic behavior (ie, histologic type, depth of invasion, tion, we include all the subcutaneous tissue down to the
and ulceration) and patterns of regional spread are essen- underlying fascia. In the scalp, we leave the galea intact to
tial for proper surgical planning. allow for skin grafting. For melanomas greater than 4-mm
in thickness, depending on the location and greatest
MANAGEMENT OF T