The role of postoperative adjuvant radiation therapy in the treatment of mucosal melanomas of the head and neck region.

BACKGROUND: Mucosal melanoma of the head and neck is uncommon, and has a poor prognosis due to locoregional and distant failure. The optimal treatment paradigm for patients with this disease has yet to be determined.

OBJECTIVE: To compare the outcomes of patients treated with various commonly used protocols for mucosal melanoma of the head and neck.

DESIGN: Retrospective study.

SETTING: Academic tertiary referral center.

PATIENTS: The medical records of 48 consecutive patients treated at a single institution from January 1, 1985, to December 31, 1998, were reviewed.

INTERVENTIONS: Patients were treated with surgery alone, surgery and adjuvant radiotherapy, or surgery and biochemotherapy, with or without adjuvant radiotherapy.

MAIN OUTCOME MEASURES: The outcomes of disease recurrence and survival were correlated with the treatment received.

RESULTS: Twenty patients received surgical treatment alone; in 9 patients (45%), this treatment failed locoregionally, and 10 (50%) of the patients developed distant metastases. The 5-year survival rate was 45% (9 of 20 patients). Twenty-four patients received postoperative adjuvant radiotherapy; in 4 patients (17%), this treatment failed locally, and 11 (46%) of the patients developed distant metastases. The 5-year survival rate was 29% (7 of 24 patients).

CONCLUSION: The addition of radiotherapy tended to decrease the rate of local failure (P =.13), but did not significantly improve survival (P =.73), because of the high rate of distant metastatic disease.