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Introduction

Melanoma is a malignant tumour that arises from neural crest-derived melanocytes that reside predominantly in the skin. Although melanoma accounts for approximately 5% of all skin cancers, it is responsible for more than 77% of skin cancer related deaths . Melanoma is an important healthcare issue, especially in Australia, which has the highest reported incidence of melanoma in the world. In Australia, the incidence of melanoma is 1 in 35 men and 1 in 25 women .

Among the subtypes of melanoma, cutaneous melanoma is the most common (91.2%) followed by ocular melanoma (5.3%) and mucosal melanoma (1.3%) . Approximately 10-30% of all cutaneous melanomas arise in the head and neck region. However, the density of cutaneous melanoma in this region compared with other body sites is very high. The head and neck region is highly exposed to sunlight and also possesses a higher density of melanocytes. Head and neck melanoma is frequently diagnosed amongst older age groups (mean age 66 years) compared with cutaneous melanoma of other regions . A recent article found a higher mortality for patients with head and neck cutaneous melanoma versus trunk and extremity cutaneous melanoma .

Besides the characteristics of the primary lesion, survival of melanoma patients is mainly influenced by the involvement of regional lymphatics and presence of distant metastases . Patients with cutaneous melanoma of the head and neck region have a 20% incidence of developing cervical node metastasis . The long term survival rate for patients with cervical lymph node metastases from head and neck melanoma is low because the disease tends to recur systemically with the 5-year survival for node positive patients (Stage III) being less than 50% .

When cervical nodal disease is present, surgery is indicated in the form of a neck dissection for regional disease control. However, there appears to be no clear evidence to guide the extent of nodal resection. The Australia and New Zealand clinical practice guidelines currently recommend comprehensive neck dissection (CND) in patients with cervical nodal metastases. Comprehensive procedures have been advocated on the basis that melanoma is an aggressive disease that needs to be radically ablated . Others suggest that limited resection by selective neck dissection (SND) is appropriate as it might offer comparable regional control rate with the benefit of less morbidity . In addition, adjuvant radiotherapy has been proposed in patients with adverse features on nodal resection. Recently published literature indicate improved regional disease control rate with adjuvant radiation. It is important to note that the overall survival remains unaffected by nodal resection or radiotherapy as patients are likely to die of distant metastasis before developing locoregional recurrence .

At our institution our practise has gradually evolved over the last decade towards performing SND more frequently compared to CND in patients with limited cervical nodal metastases. To examine the effect of extent of nodal resection we retrospectively evaluated relevant clinical attributes and outcome in patients who had undergone neck dissection for cervical nodal metastases from head and neck cutaneous melanoma.