What is the role of surgery in the treatment of oral malignant melanoma?

Updated: Jan 31, 2020
  • Author: Elizabeth Ann Bilodeau, DMD, MD, MSEd; Chief Editor: Jeff Burgess, DDS, MSD  more...
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As primary therapy, ablative surgery with tumor-free margins remains the treatment of choice unless lymph node or distant metastasis exists. Early surgical intervention when local recurrence is detected enhances survival, because the dismal outcomes are associated with distant metastasis. About 80% of patients with oral melanoma have local disease, and 5-10% of patients present with grossly involved cervical and/or supraclavicular lymph nodes. After complete surgical excision, the local-regional relapse rate is reported to be 10-20%, and 5-year survival rates are clustered around 10-25%, with a reported range of 4.5-48%. McKinnon et al reported that tertiary care centers have the best results. [21]

Electrodesiccation and cryosurgery are described as treatment modalities for early, superficial, palatal lesions. However, incomplete removal results in recurrence that may envelop the previous biopsy, excision, or treatment site and interfere with histologic evaluation. These methods have little or questionable benefit in the treatment of oral melanoma.

Although radiation alone is reported to have questionable benefit (particularly in small fractionated doses), this therapy is a valuable adjuvant in achieving relapse-free survival when high-fractionated doses are used. [22]  Radioimmunotherapy trials are currently under way at many large medical centers.

Surgical lymph node harvesting depends on the identification of positive nodes at clinical or imaging examination. Neither lymphoscintigraphy nor intraoperative blue-dye sentinel-node biopsy (eg, selective neck dissection) is useful in predicting drainage patterns in oral melanomas. Anatomic ambiguity appears to preclude consistent assessment of oral lymphatic drainage patterns when this technique is attempted.

Prophylactic neck dissection (ie, elective neck dissection) is not advocated as a treatment for oral melanoma.

Eventually, multimodal therapy may be proven effective in the treatment of oral mucosal melanoma.

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