AAO-HNSF Primary Care Otolaryngology Handbook

SKIN CANCER

climates. One important point to recognize is that melanomas of the head and neck often display different behavioral tendencies than those in other areas of the body. Melanoma frequently presents as a pigmented lesion , often a mole, that has advanced through radial and vertical growth, color, margin integrity, ulceration, or bleeding. Melanoma begins in the epidermis and then invades the dermis. The depth of invasion is strongly predictive of risk of metastases and ultimately patient survival. The Breslow classifi- cation system includes thin (1-mm invasion or less), intermediate (greater than 1 mm and less than 4 mm), and thick (greater than 4 mm). The risk of metastatic disease is less than 10 percent with thin lesions but greater than 90 percent with thick ones. It is important that the primary physician and dermatologist remain vigilant for darkly pigmented moles and those that have changed, bleed, are raised, or have irregular margins. Early detection and excision are critical to patient outcomes. The initial treatment of cutaneous melanomas after diagnosis and determination of depth is wide (2 cm) surgical resection and, when appropriate, sentinel node lymphoscintigraphy to determine the first echelon of the draining lymphatic basin and identification of nodes at the highest risk for metastatic involvement. Subsequently, parotidec- tomy, selective nodal dissection, bioimmunotherapy, and radiation may all be used to treat head and neck melanoma at some point in the patient’s care.

93

www.entnet.org