Relapse of melanoma in head and neck after surgery: effect of radiation therapy

The authors analyzed the patterns of relapse in patients with head and neck melanoma treated with surgery and radiation therapy.

Skin melanoma of head and neck is often associated with poor survival. Surgical removal of the affected lymph nodes (tiny, bean-shaped organ that help fight infection) along with the melanoma in these sites is the standard treatment. However, relapse of head and neck melanoma (HNM) after surgery is common and frequently spreads to distant parts of the body. So, the usefulness of local melanoma treatment with radiation therapy (directing a beam of radiation to the tumor site to kill cancer cells) after surgery is debatable.

An understanding of the factors that predict recovery and relapse patterns in patients with HNM will be helpful in determining appropriate treatment option in future.

The authors aimed to analyze the patterns of relapse in patients with stage 3B/3C (spread to the lymph nodes) HNM after lymph node surgery and additional radiation therapy.

Data from 173 patients were analyzed in this study. The average follow-up time was 32 months. 38% received radiation after surgery (group 1). The rest of the patients had only surgery (group 2).  

For group 1 patients, the 5-year rate of relapse at distant body parts was 60%, 17% at neck lymph nodes and 31% in the lymphatic system (part of the circulatory system).  For group 2 patients, the rate of 5-year relapse at distant body parts was 38%, 10% at neck lymph nodes and 13% in the lymphatic system. The overall rate of relapse at the head and neck region for all patients was 23%.

19 patients (10.9%) experienced relapse at the neck region only. 17 (89.5%) of these patients received salvage therapy (another surgery): 10 patients received both surgery and radiation therapy and 2 patients received radiation alone. 63.1% of these 19 patients had cancer spread to distant parts within 12 months of salvage therapy, and 21% were disease-free.

The authors concluded that relapse of HNM only at the neck region was effectively controlled by further surgery and radiation therapy.

Although local relapse can effectively controlled by surgery and radiation therpay, metastasis at the distant body parts occured frequently.