Perry Shen, MD

Radiation therapy is not part ofthe traditional treatment approachto cutaneous melanoma.Aggressive surgical resection ofboth the primary site and regional nodalmetastases has long been consideredthe only option for achievinglong-term disease-free and overall survival.Many patients who present withmelanoma have thin lesions (< 1 mmBreslow thickness) and are essentiallycured with a wide local excision ofthe primary site. Patients with thickermelanomas and clinically negativeregional nodal basins often undergowide excision and sentinel node biopsyto identify occult nodal metastases.Those who have a sentinel lymphnode positive for metastatic diseaseor clinically positive nodes undergo atherapeutic lymph node dissection toprovide local control and possibly preventdistant metastatic disease. Recentarticles such as the one by Balloand Ang, however, highlight the in-creasedrole of external-beam radiationtherapy in the treatment of malignantmelanoma.

Head and neck melanoma is a rare and aggressive childhoodmalignancy. Surgery remains the primary treatment, with lymphaticinvolvement determined by neck dissection. In the adult population,sentinel lymph node biopsy has emerged as a less morbid yet accuratemethod of staging regional lymph nodes. This innovative technique canalso be used in the pediatric population.