title: Neck dissection for oral mucosal melanoma: caution of nodular lesion.
abstract: BACKGROUND
  Oral mucosal melanoma (OMM) often metastasizes to cervical nodes. A great number of studies have been conducted to evaluate the efficacy of neck dissection in the treatment of OMM, but considerable controversy remains in this field.
  
  
  METHODS
  The clinical features, treatments, and outcomes of 254 OMM patients were retrospectively analyzed from Jan. 1998 to Jul. 2012. Multivariate analysis was performed to identify the variables related to overall survival (OS).
  
  
  RESULTS
  Tumor size greater than 4 cm (p=0.01) and nodular types (p<0.0001) were independent prognostic factors for OS. Patients with nodular melanomas were more likely to have distant metastases than those with macular melanomas (p<0.0001). 164 Patients (65%) had CLN metastases. The multivariate analysis revealed that prophylactic neck dissection was an independent favorable factor for OS (p=0.0016) in patients with cN0 nodular melanomas; whereas radical neck dissection (p=0.03) in patients with positive CLN. Patients undergoing functional neck dissection were more likely to have neck recurrence (p<0.001).
  
  
  CONCLUSIONS
  Nodular type is a dangerous signal to OMM. It is advisable for patients with cN0 nodular melanomas to have prophylactic neck dissection, close observation is recommended for patients with cN0 macular melanomas, and patients with positive CLN should undergo radical neck resection.
authors.affiliation: Dept. of Oral & Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, People's Republic of China.
authors.forename: Yunteng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Institute of Stomatology, Department of Oral Pathology, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhong
authors.affiliation: Dept. of Oral & Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, People's Republic of China.
authors.forename: Chaojun
authors.initials: C
authors.lastname: Li
authors.affiliation: Dept. of Oral & Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, People's Republic of China.
authors.forename: Hao
authors.initials: H
authors.lastname: Song
authors.affiliation: Dept. of Oral & Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, People's Republic of China. Electronic address: guoweicn@yahoo.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.affiliation: Dept. of Oral & Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, People's Republic of China. Electronic address: renguoxincn@hotmail.com.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Ren
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009061:Mouth Mucosa / Q000473:pathology*
keywords: Melanoma; Neck dissection; Nodular; Oral; Prognosis