Two Cases of Parotid Lymph Node Metastases of Cutaneous Head and Neck Melanoma; The Management of Parotid Region and Cervical Lymph Nodes

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  • Nakamura Yasuhiro
    Department of Dermatology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Nakamura Yoshiyuki
    Department of Dermatology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Ishii Yoshiyuki
    Department of Dermatology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Furuta Junichi
    Department of Dermatology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Kawachi Yasuhiro
    Department of Dermatology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba
  • Otsuka Fujio
    Department of Dermatology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba

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Other Title
  • 耳下腺リンパ節転移を生じた頭頸部皮膚原発悪性黒色腫―耳下腺領域および頸部リンパ節の取り扱いに関して―
  • ジカセン リンパセツ テンイ オ ショウジタ トウケイブ ヒフ ゲンパツ アクセイ コクショク シュ ジカセン リョウイキ オヨビ ケイブ リンパセツ ノ トリアツカイ ニ カンシテ

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Abstract

We treated two cases of parotid lymph node metastases of cutaneous head and neck melanoma. Case 1, a 35-year-old man, had a melanoma on the right cheek (tumor thickness: 1.7 mm). Parotid lymph node micrometastasis was detected by sentinel lymph node (SLN) biopsy. Superficial parotidectomy and selective neck dissection (SND) (level I and II) were performed. The pathologic staging was pT2aN1aM0 stage IIIA. Six courses of DAV-Feron therapy were added as adjuvant therapy, and the patient is free of disease 62 months after the operation. Case 2, a 40-year-old woman, had a melanoma on the left temple (tumor thickness: 22 mm). A parotid node metastasis, 1.5 cm in diameter, was detected by SLN biopsy. Superficial parotidectomy and SND (level I, II and III) were performed. The pathologic staging was pT4bN1bM0 stage IIIC. Despite adjuvant therapy using a course of DAV-feron, parotid lymph node metastasis reoccurred 4 months after the operation. After the local excision of this metastatic lymph node, additional radiotherapy for parotid region and neck was employed. Eight months after the operation, lung metastases arose, and several courses of DTIC therapy have been performed. We discussed the surgical management of parotid region and cervical lymph nodes and the additional postoperative local treatment options such as radiotherapy when parotid lymph node metastases are detected. We conclude that SND of levels I to III and superficial parotidectomy including preauricular node dissection should be applied in cases of parotid lymph node metastases.

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