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Jan/Feb 2017

Management Controversies in Head and Neck MelanomaA Systematic Review

Author Affiliations
  • 1Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine, St Louis, Missouri
  • 2Department of Dermatology, Washington University School of Medicine, St Louis, Missouri
  • 3Department of Medicine, Washington University School of Medicine, St Louis, Missouri
  • 4Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins University School of Medicine, Bethesda, Maryland
JAMA Facial Plast Surg. 2017;19(1):53-62. doi:10.1001/jamafacial.2016.1038
Key Points

Question  Based on the current evidence available, what is the standard of care for management of head and neck melanoma?

Findings  In this systematic review, workup and treatment options for melanoma were reviewed with an emphasis on guidelines for surgical margins, when to do sentinel lymph node biopsy, and when to refer for adjuvant treatment. Patients with desmoplastic melanoma or cervical nodal disease should be referred for consideration of adjuvant radiation. Patients with stage IIb or greater disease should be evaluated by medical oncology for consideration of systemic therapy.

Meaning  Melanoma of the head and neck is primarily a surgical disease, but optimal management depends greatly on appropriate workup and staging, and requires multidisciplinary consideration.


Importance  Head and neck melanoma is one of the leading causes of death in the United States and is currently increasing in prevalence. While there is a tremendous amount of research published on melanoma, the actual evidence for complex clinical decision-making can be difficult to interpret and to stay up-to-date on current clinical standards.

Objective  To address, in a systematic and evidence-based approach, the most common clinical controversies with regard to the workup and management of head and neck melanoma.

Evidence Review  A PubMed and Medline search was performed of the entire English literature with respect to head and neck melanoma. Priority of review was given to those studies with higher-quality levels of evidence.

Findings  Main topics reviewed in this article include workup for new melanoma, surgical treatment of the primary site, surgical treatment of the neck, adjuvant radiation therapy, and systemic therapy. Levels of evidence are used for each controversial clinical question to help the clinician understand the reliability of the current evidence when making complex clinical decisions for melanoma management of the head and neck. However, much of the work done in melanoma, particularly large randomized clinical trials, includes many other regions of the body. Therefore, these data must be interpreted in light of the potential differences in clinical behavior and draining lymphatics between trunk, limbs, and head and neck subsites.

Conclusions and Relevance  The management of head and neck melanoma requires a multidisciplinary approach, particularly for advanced-stage disease. An in-depth knowledge of the current evidence available will help guide the surgeon in the management of this difficult disease.