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.