title: Treatment outcome for 424 primary cases of clinical I cutaneous malignant melanoma of the head and neck.
abstract: BACKGROUND
  Cutaneous malignant melanoma (CMM) is increasing in frequency. Surgery remains the primary and only curative treatment method. Our aim was to define prognostic factors and outcome predictors for patients with clinical stage I CMM of the head and neck.
  
  
  METHODS
  Surgical treatment and outcome was analyzed for 424 patients with clinical stage I melanoma of the head and neck, completing initial treatment at the Mayo Clinic (1970-1990). The data were analyzed using the Kaplan-Meier product-limit method and Cox multiple-regression models.
  
  
  RESULTS
  Overall, 180 (42%) patients underwent elective lymph node dissection (ELND) as part of the initial treatment; occult disease was demonstrated in 15 (8.3%). Among patients with tumor > 1.5 mm thick, occult regional disease was found in 15%. Failure of final treatment occurred in 152 (36%). Overall, 82% and 75% of the patients survived 5 and 10 years, respectively.
  
  
  CONCLUSIONS
  Tumor thickness, extent of invasion, and the presence of occult region metastatic disease were the only independently predictive value (p < .005) of recurrence. The detection of disease by ELND did not appear to protect the patient from disease progression but identified those with regionally advanced disease and highest risk for recurrence. The development of recurrence significantly reduced but did not eliminate the potential for extended disease-free survival with subsequent treatment.
authors.affiliation: Department of Surgery, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minnesota 55906, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Kane
authors.forename: P
authors.initials: P
authors.lastname: Yugueros
authors.forename: R P
authors.initials: RP
authors.lastname: Clay
authors.forename: J E
authors.initials: JE
authors.lastname: Woods
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D005260:Female; D005544:Forecasting; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012044:Regression Analysis; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome