H. CALHOUNKARENMDB. KUPPERSMITHRONALDMD
Myers' charge was to present a well-balanced, up-to-date discussion on the efficacy of ELND for intermediate-thickness melanomas of the head and neck. To this end, he has done a commendable job of discussing the pros and cons of ELND, primarily as it relates to the addition of adjunctive therapy (interferon alfa-2b and high-dose hypofractionated radiation therapy) to improve survival and increase local and regional control.
These strategies are designed primarily for those patients who are at high risk for developing metastatic disease, in other words, those who have clinically positive lymph nodes at diagnosis or who have been diagnosed as having positive occult disease at surgery. By incorporating a new technology for identifying patients with occult disease, that is, using intraoperative sentinel lymphadenectomy instead of prophylactic ELND, valuable prognostic information will be obtained, thereby identifying the patients who would benefit from the addition of adjunctive therapy. Myers summarized the recent literature that addresses these subjects and suggested the incorporation of this strategy.
Fisher SR. Considerations in the Surgical Treatment of Malignant Melanoma. Arch Otolaryngol Head Neck Surg. 1999;125(1):116-117. doi:10.1001/archotol.125.1.116