Abstract 15.30 LIFE-SAVING SURGICAL EXCISION OF GIANT MALIGNANT MELANOMA METASTASIS

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INTRODUCTION: Surgical excision of malignant melanoma is critical for establishing the diagnosis but also for complete management. The prognosis for stage IV melanoma is poor, with only 10% to 15% of patients living past 5 years. Being the most deadly form of skin cancer, the malignant melanoma metastasis excision represents a palliative treatment. MATERIAL AND METHODS: After evaluating the general status and establishing the staging of malignant melanoma in a 66 year old man, we decided to excise a giant left laterocervical metastasis. After a thorough analysis of imaging investigations we performed a radical neck dissection that involved skeletization of internal carotid artery and internal jugular vein, radical cervical lymphadenectomy, lymphatic duct removal, sacrifice of the hypoglossal nerve, external carotid artery, inferior pole of the parotid gland, mandibular periosteum; followed by local deltopectoral rotated flap coverage and skin graft. RESULTS: Postoperative status was favourable, with total removal of the cervical metastasis based on the anatomopathological result and the following MRI one month after surgery. CONCLUSION: Surgical excision of stage IV malignant melanoma is not a curative therapy. The complexity and the challenge of the case relies on the fact that the primary lesion has not been detected, only the secondary determinations have been traced and totally excised. Due to local invasion to the near proximity of internal carotid artery and internal jugular vein, surgery has been life-saving. The follow up resides in regular clinical examination and imaging investigations.

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