John Joseph Conley – The Treatment of Melanoma in the Head and Neck

Written by Dr Patrick Gullane, CM, OOnt, MB, FRCSC, FACS, Hon FRACS, Hon FRCS, Hon FRCSI
Wharton Chair in Head & Neck Surgery
Professor Department of Otolaryngology-Head & Neck Surgery

The Experience between 1935 to 1962 of 772 melanomas involving the head and neck seen at the Pack Medical Foundation (PMF) is presented with the main emphasis of 660 cutaneous and mucosal melanomas. Clark’s levels for pathologic invasion are presented and correlated to 289 cases with 19 percent in Level II and 81 percent deeply invasive at Level III, IV, and V. The face was the most common location with the cheek alone accounting for 22.3 percent of all the cases. The male to female ratio was 1.5 to 1 with 76 percent of the cases being equally distributed among the fourth through the seventh decades. 55.9 percent were local disease, Stage I, with 33.5 percent, Stage II, and 10.6 percent, Stage III or distal disease. The five-year or greater absolute cure rate in positive nodal disease was 12.6 percent. Elective versus no elective neck dissection in Stage IA disease demonstrated a five-year or greater absolute cure rate of 55 percent as compared to 38.5 percent. Distal metastases occurred in 30 percent of cases with elective neck dissection but in 70 percent of those cases with therapeutic neck dissection. The absolute five-year or greater cure rate was able to be analyzed in 556 cases. The rate was 25.6 percent for the mucosal and cutaneous lesions combined; an 8 percent rate for mucosal alone and 27.8 percent for cutaneous melanoma. The five-year or greater absolute cure rate for those cases treated totally at PMF was 35.4 percent. Reconstruction included local rhomboid flaps, bilobed flaps, cervical rotation flaps and with more extensive resections and regional flaps to include the Thoraco-dorsal flap and the Bakamjian –Deltopectoral flap. Decision around reconstruction depended on the extent of the defect, location to vital structures and finally best color match.