INVITED COMMENTARY This paper describes the experience of one surgical group 2a), chemotherapy, vaccine therapy and radiotherapy in managing patients with melanoma of the head and are being evaluated to determine the optimal approach. neck. Fifty-six patients were treated between 1977 and The correct management of patients with a high-risk 1993 and followed for between 2 and 18 years (mean (thick, deep) primary melanoma and clinically negative 7.5 years). The patients are divided into three groups. regional nodes is less clear. Until recently there were Twenty-four patients received, ªplanned definitive sur- two options, elective node dissection and a ªwatch and gery.º This is defined as local excision with adequate waitº policy, with therapeutic node dissection if and when margins and ª selective modified lymph node dissectionº the nodes became clinically positive. Clinical experience within two months of initial diagnosis for ªhigh riskº pa- and extensive studies of patients treated by elective node tients (superficial spreading or nodular melanoma thicker dissection suggest that a subroup of patients may benefit than 1 mm). Ten received ªnon-planned definitive sur- from elective nodal dissection, but give no guidance as to geryº, more than 2 months having elapsed since initial di- how such patients may be European Journal of Plastic Surgery Springer Journals


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Copyright © 1999 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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