Neck Dissection and Parotidectomy for Melanoma

Head and neck melanomas are a surgical and medical challenge. Facial anatomy and its lymphatic drainage are complex and often unpredictable. To balance oncologic clearance with morbidity, surgeons must be familiar with the anatomy of the head and neck region, possible patterns of nodal drainage, and regions of potential anatomic danger. Unless facial surgery is part of a surgeon’s common practice, facial nerve injury and soft tissue embarrassment can result. Although head and neck melanomas are treated similarly to other body regions, they are often underrepresented in clinical trials, making extrapolation difficult. Thus, the surgeon must be aware of current clinical data and tailor care to each individual patient. The goal of this chapter is to review head and neck lymphatics, discuss relevant surgical techniques, and review clinical evidence relating to sentinel node biopsy and complete neck dissection in head and neck melanomas.