The surgical management of malignant melanoma has long been a highly controversial subject. The basic principle of wide excision of the primary site is generally accepted as the proper management of the primary lesion.
The controversy, however, surrounds the appropriate management of the regional lymph nodes. It is generally admitted that, in patients with Clark levels Ⅲ, Ⅳ, Ⅴ and all melanomas that are greater than 1.5mm in thickness, the nodes in neck should be removed, even if they are not clinically suspicious nodes.
In the past, it was believed that the nodes in neck should be removed only by the classical redical neck dissection. But now the functional or modified neck dissection markedly increases as an elective operation, since it not only shows no significant difference in the risk of recurrence, compared with classical redical neck dissection, but also is functionally, esthetically, and physiologically acceptable. The ideal candidates of the functional neck dissection are those patients who have clinically No necks but whose primaries have signified chance of having microscopic metastases to the lymph nodes and, as such, are considered for elective neck dissection.
The authors herein, experienced a patient with Clark level Ⅳ melanoma in the face and no suspicious lymph nodes in the neck, who was successfully managed wide reexcision and functional neck dissection through the incision of the cervicofacial flap.
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