RESUMEN
OBJECTIVES: This study evaluates the outcome of pharyngoesophageal reconstruction using radial forearm free flaps with regard to primary wound healing, speech, and swallowing in patients requiring laryngopharyngectomy. STUDY DESIGN: Retrospective review in the setting of a tertiary, referral, and academic center. PATIENTS AND METHODS: Twenty patients underwent reconstruction of the pharyngoesophageal segment using fasciocutaneous radial forearm free flaps. RESULTS: All free flap transfers were successful. An oral diet was resumed in 85% of the patients after surgery. Postoperative pharyngocutaneous fistulas occurred in 4 patients (20%) with 3 resolving spontaneously. Distal strictures also occurred in 20% of the patients. Five patients who underwent tracheoesophageal puncture achieved useful speech. CONCLUSIONS: Advantages of radial forearm free flaps for microvascular pharyngoesophageal function include high flap reliability, limited donor site morbidity, larger vascular pedicle caliber, and the ability to achieve good quality tracheoesophageal speech. The swallowing outcome is similar to that achieved after jejunal flap pharyngoesophageal reconstruction. The main disadvantage of this technique relates to a moderately high incidence of pharyngocutaneous fistulas, which contributes to delayed oral intake in affected patients.
Asunto(s)
Esofagoplastia/métodos , Faringe/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Carcinoma de Células Escamosas/cirugía , Femenino , Antebrazo , Humanos , Hipofaringe/cirugía , Masculino , Persona de Mediana Edad , Neoplasias Faríngeas/cirugía , Complicaciones Posoperatorias , Voz EsofágicaRESUMEN
A retrospective review of 14 patients with adenoid cystic carcinoma of the tongue treated between 1955 and 1997 was performed. Treatment consisted of surgery (n = 2), radiotherapy (n = 2), chemotherapy (n = 1), or combination therapy (n = 9). The 2-, 5-, and 10-year absolute survival rates were 92%, 79%, and 63%, respectively. Seventy-five percent of the patients who died of cancer succumbed to distant metastases. However, long-term survival was common despite a high incidence of local and distant recurrence. The presence of positive surgical margins, the incidence of regional metastases, the incidence of perineural invasion, the initial stage of disease, and the eventual development of locoregional recurrence and distant metastases did not significantly alter the survival rate. Surgical extirpation combined with postoperative radiotherapy is advocated for the treatment of adenoid cystic carcinoma of the tongue. Given the indolent nature of this disease process, surgery should be directed toward conservation of speech and swallowing function.
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Carcinoma Adenoide Quístico/terapia , Neoplasias de la Lengua/terapia , Adulto , Anciano , Carcinoma Adenoide Quístico/mortalidad , Carcinoma Adenoide Quístico/secundario , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias de la Lengua/mortalidad , Neoplasias de la Lengua/patologíaRESUMEN
OBJECTIVE: The retropharyngeal space is a deep neck space susceptible to a host of disease processes. Surgical access to this space is technically difficult and associated with potential morbidity. An image-guided fine-needle aspiration (FNA) biopsy, if proven accurate and safe, would be of great benefit as an alternative diagnostic approach to this space. This study reports on the use of magnetic resonance imaging (MRI)--guided FNA for diagnostic evaluation of retropharyngeal lesions. Technical details of needle systems, approach to this space, and reliability of this method are described. STUDY DESIGN: This is a prospective study of 14 patients with retropharyngeal lesions who underwent MRI-guided FNA biopsy at the University of California at Los Angeles Center for the Health Sciences between October 1989 and October 1998. METHODS: A 0.2-tesla open magnet was used to obtain magnetic resonance images of each retropharyngeal lesion. After standard skin preparation a coaxial needle system was used to reach and sample the lesion. In most instances, the specimen was immediately stained and examined by a cytopathologist for adequacy before removing the patient from the scanner. RESULTS: Eleven of 14 (78%) patients had diagnostic aspirations; only 2 of these 11 patients required additional surgical biopsy for more specific histological characterization of their lesions before definitive treatment recommendations were given. All aspiration procedures were well tolerated and without any complications. CONCLUSION: We have demonstrated that MRI-guided approach to the retropharynx is feasible, safe, and sensitive enough to obviate the need for open biopsies in a large percentage of patients.
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Biopsia con Aguja/instrumentación , Imagen por Resonancia Magnética/instrumentación , Neoplasias Faríngeas/patología , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Diagnóstico Diferencial , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Faríngeas/secundario , Faringe/patologíaRESUMEN
Sarcoidosis is a chronic granulomatous disease of unknown etiology. Otolaryngologic and ophthalmologic manifestations occur in 15 to 55% of afflicted individuals, respectively. Neck masses, parotid enlargement, and facial nerve palsy are the most common presenting otolaryngologic complaints, while lacrimal gland enlargement, uveitis, and upper eyelid masses often call the attention of the ophthalmologist. Biopsy reveals non-caseating granulomas, while the angiotensin converting enzyme (ACE) level may be elevated. We report an unusual case of a patient who presented with severe bilateral exophthalmos as the sole initial complaint. A prior workup included a negative conjunctival biopsy. On magnetic resonance imaging (MRI) and computed tomography (CT), the patient had pansinusitis. Endoscopic ethmoidectomies with tissue analysis revealed sarcoidosis. Further evaluation revealed no evidence of systemic disease, and all symptoms resolved with a course of oral steroids. Thus, nasal endoscopy and biopsy of affected paranasal sinus mucosa may prove a useful adjunct to the diagnosis of sarcoidosis, particularly in atypical cases.
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Endoscopía , Exoftalmia/etiología , Sarcoidosis/diagnóstico , Sinusitis/etiología , Adulto , Biopsia , Diagnóstico Diferencial , Exoftalmia/patología , Femenino , Humanos , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/etiología , Senos Paranasales/patología , Sarcoidosis/complicaciones , Sinusitis/patologíaAsunto(s)
Boca/cirugía , Orofaringe/cirugía , Procedimientos de Cirugía Plástica , Colgajos Quirúrgicos , Humanos , Recién Nacido , MétodosRESUMEN
PURPOSE: Treatment regimens for head and neck cancer patients profoundly affect several quality-of-life domains. Rehabilitative needs have been identified through cross-sectional analyses; however, few studies have prospectively assessed quality of life, included assessment of psychosocial variables, and identified predictors of long-term follow-up. PARTICIPANTS AND METHODS: The present study addresses these limitations through a prospective assessment of 105 patients with a newly diagnosed first primary squamous cell carcinoma of the oral cavity, pharynx, or larynx. Participants were enrolled onto a larger randomized controlled trial comparing a provider-delivered smoking cessation intervention with a usual-care-advice control condition. Participants completed a battery of self-report measures after diagnosis and before treatment and additional quality-of-life instruments at 1 and 12 months after initial smoking cessation advice. RESULTS: Participants displayed improvements at 12 months in functional status (P = .006) and in the areas of eating, diet, and speech; however, the latter three represent areas of continued dysfunction, and the changes were not statistically significant. Despite these improvements, patients reported a decline in certain quality-of-life domains, including marital (P = .002) and sexual functioning (P = .017), as well as an increase in alcohol use (P < .001). Predictors of quality of life at 12 months included treatment type, the Vigor subscale of the Profile of Mood States instrument, and quality-of-life scores obtained 1 month after initial smoking cessation advice. CONCLUSION: Results reinforce the need for rehabilitation management through the integration of psychologic and behavioral interventions in medical follow-up.
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Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/terapia , Calidad de Vida , Actividades Cotidianas , Consumo de Bebidas Alcohólicas , Ingestión de Alimentos , Femenino , Neoplasias de Cabeza y Cuello/psicología , Humanos , Estado de Ejecución de Karnofsky , Neoplasias Laríngeas/psicología , Neoplasias Laríngeas/terapia , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/psicología , Neoplasias de la Boca/terapia , Neoplasias Faríngeas/psicología , Neoplasias Faríngeas/terapia , Estudios Prospectivos , Fumar , HablaRESUMEN
BACKGROUND: Smoking withdrawal and relapse were characterized among newly diagnosed head and neck cancer patients participating in a physician-delivered smoking cessation intervention. METHODS: Patients completed questionnaires at baseline, 1, 6, and 12 months following intervention delivery. RESULTS: Significant baseline predictors of smoking relapse included medical treatment (XRT versus surgical treatment), stage of change/readiness to quit (precontemplators), age of initiation (younger), and greater addiction (smoking =30 minutes after waking). Relapsers were significantly more likely to quit using gradual reduction versus cold turkey and had less confidence in remaining quit. Relapsers experienced significantly higher levels of anxiety and craving during withdrawal. Relapse was temporally delayed compared with healthy populations. CONCLUSION: Assistance with cessation efforts should be ongoing for one year and should include nicotine replacement therapy and psychotropic medications to address significant relapse triggers.
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Neoplasias Laríngeas , Neoplasias de la Boca , Neoplasias Faríngeas , Cese del Hábito de Fumar , Fumar , Afecto , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Fumar/psicología , Síndrome de Abstinencia a SustanciasRESUMEN
OBJECTIVE: Early stage squamous cell carcinoma of the tonsil is amenable to treatment by either surgery or radiation therapy as a single modality, with comparable rates of local control. Unfortunately, manifestation of the disease at an early stage is infrequent, and surgery or radiation alone is less successful in controlling advanced disease. This study was conducted to elucidate the optimal treatment plan for advanced stages of tonsillar carcinoma and to identify significant risk factors for development of recurrence or failure of local control. METHOD: We reviewed the UCLA experience with treatment of all stages of tonsillar carcinoma between 1970 and 1990. RESULTS: Actuarial local control rates were 70% for T1, 72% for T2, 50% for T3, and 0% for T4 at 5-year follow-up. Local control and overall survival rates were compared according to the type of treatment rendered for each stage. CONCLUSIONS: From our analysis we conclude that aggressive combination therapy with surgery and radiation yields significantly higher local control rates for stages 3 and 4 tonsillar carcinomas. The advantages and disadvantages of preoperative versus postoperative radiation therapy are discussed.
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Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Neoplasias Tonsilares/radioterapia , Neoplasias Tonsilares/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Dosificación Radioterapéutica , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Neoplasias Tonsilares/patología , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
PURPOSE: Early experience has shown that positron-emission tomography (PET) is a useful technique for the detection of occult squamous cell carcinoma of the head and neck. Although highly sensitive, PET lacks definition of anatomic detail and therefore does not localize pathology precisely. To circumvent this limitation, a computerized coregistration technique has been developed at the University of California-Los Angeles to correlate PET and magnetic resonance images (MRI). This method allows accurate, precise anatomic localization of areas of heightened glucose metabolism, including subclinical tumors. MATERIALS AND METHODS: The technique uses a coregistration computer program that precisely superimposes the PET scan with the corresponding MRI image. RESULTS: Two cases are presented in which PET-MRI coregistration was used to anatomically define the areas of heightened glucose metabolism. Large tumors were selected because the precision of the method can be verified. CONCLUSION: The coregistration technique is a valuable addition to PET imaging, particularly in its ability to anatomically localize PET findings. The most important application of this technique is to facilitate the biopsy of subclinical lesions identified on PET.
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Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada de Emisión/métodos , Anciano , Femenino , Fluorodesoxiglucosa F18 , Humanos , Persona de Mediana EdadRESUMEN
Rhinocerebral mucormycosis is recognized as a potentially aggressive and commonly fatal fungal infection. The classic presentation is involvement of nasal mucosa with invasion of the paranasal sinuses and orbit. Mucormycosis is most commonly seen in association with diabetic ketoacidosis, but disease demographics have changed with the onset of AIDS and the advent of powerful immunosuppressive drugs. Treatment includes aggressive debridement, systemic antifungal therapy, and control of underlying comorbid factors. Although surgical intervention remains essential, advances in medical therapy have permitted a more limited surgical approach to minimize functional loss without compromising survival. We present the UCLA experience with rhinocerebral mucormycosis from 1955 to 1995, with emphasis on the evolution of disease presentation and alternative treatment options.
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Encefalopatías/microbiología , Mucormicosis/diagnóstico , Enfermedades Nasales/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Adolescente , Adulto , Anciano , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Encefalopatías/diagnóstico , Encefalopatías/cirugía , Niño , Terapia Combinada , Desbridamiento , Cetoacidosis Diabética/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Huésped Inmunocomprometido , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Mucormicosis/cirugía , Mucosa Nasal/microbiología , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/cirugía , Infecciones Oportunistas/diagnóstico , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/microbiología , Enfermedades Orbitales/cirugía , Enfermedades de los Senos Paranasales/diagnóstico , Enfermedades de los Senos Paranasales/microbiología , Enfermedades de los Senos Paranasales/cirugía , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Anomalías Múltiples , Enfermedades de la Laringe/complicaciones , Enfermedades de la Tráquea/complicaciones , Artrogriposis/complicaciones , Encéfalo/anomalías , Pie Equinovaro/complicaciones , Constricción Patológica , Cara/anomalías , Humanos , Recién Nacido , Pulmón/anomalías , Masculino , SíndromeRESUMEN
Severe malnutrition (< 65% ideal body weight [IBW]) is associated with reduced insulin secretion, decreased receptor affinity, and glucose intolerance. To characterize the abnormality of mild malnutrition in terms of insulin action, both the insulin sensitivity index and insulin secretion were measured in 15 underweight and 15 normal-weight volunteers. Ten patients had localized squamous cell carcinomas of the head and neck, and 20 were normal controls. After a 10-hour overnight fast, all volunteers were studied using Bergman's modified intravenous (IV) glucose tolerance test (IVGTT). Body weight and diagnosis were compared using a 2 x 2 ANOVA. The acute insulin response to IV glucose was reduced in normal-weight and underweight cancer patients by approximately 40% to 50% (P < .05). Both groups of cancer patients had a significantly reduced rate of glucose disposal (1.25 +/- 0.29 and 1.27 +/- 0.23 %/min) compared with the healthy volunteers (1.82 +/- 0.21 and 1.81 +/- 0.24 %/min, respectively, P < .05). Glucose production (GP) was significantly increased in the underweight cancer patients versus the weight-matched volunteers (13.9 +/- 1.3 v 10.8 +/- 0.5 micromol/kg/min, P < .05). Normal-weight and underweight cancer patients had a 32% to 44% reduction in insulin sensitivity (P < .05). In contrast to the effects of cancer, underweight controls had twice the insulin sensitivity compared with normal-weight controls (P < .01). Since insulin secretion decreased in underweight controls, the increased insulin sensitivity may have been due to an increased insulin action and to factors associated with leanness.
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Glucemia/metabolismo , Peso Corporal/fisiología , Neoplasias de Cabeza y Cuello/metabolismo , Insulina/metabolismo , Delgadez/metabolismo , Antropometría , Prueba de Tolerancia a la Glucosa , Humanos , Hipoglucemiantes/farmacología , Secreción de Insulina , Islotes Pancreáticos/metabolismo , Hígado/metabolismo , Persona de Mediana Edad , Sensibilidad y Especificidad , Tolbutamida/farmacología , Factor de Necrosis Tumoral alfa/análisisRESUMEN
PURPOSE: The clinicopathologic distinctions between angiolymphoid hyperplasia with eosinophilia (AHE) and vascular tumors are controversial. Some investigators believe that AHE is a variant of hemangioma, whereas others state that it is an inflammatory phenomenon. To better delineate the clinicopathologic entity of AHE and investigate the efficacy of various treatment regimens, we undertook a retrospective analysis of AHE and compared it with other angiomatous lesions treated at a tertiary referral center. MATERIALS AND METHODS: We reviewed the histopathologic features of hemangioma, AHE, and angiosarcoma of the head and neck seen in 46 cases at University of California Los Angeles (UCLA) Medical Center between 1950 and 1992. Lesions were evaluated for presence of lymphoid and eosinophilic infiltration, type of endothelial cell, and pattern of vascular proliferation. Patient charts were also reviewed for clinical history and outcome. RESULTS: The typical findings of AHE were present in 13 cases of conventional hemangioma and angiosarcoma. The clinical data of 8 AHE patients were also reviewed and a benign outcome was observed. CONCLUSION: We propose that AHE represents an angiomatous neoplasm similar to the hemangioma but characterized by a marked reactive appearance. AHE may comprise part of a spectrum of vascular tumors with differences between lesions depending in part on host-mediated inflammatory and immune responses.
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Hiperplasia Angiolinfoide con Eosinofilia/diagnóstico , Adulto , Hiperplasia Angiolinfoide con Eosinofilia/patología , Diagnóstico Diferencial , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/ultraestructura , Hemangioma/diagnóstico , Hemangioma/ultraestructura , Hemangiosarcoma/diagnóstico , Hemangiosarcoma/ultraestructura , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Lichen planus of the oral mucosa (OLP) is characterized by lymphocytic mucositis, basal cell lysis, and lymphocyte transmigration into the epithelial compartment. Some reports have suggested a high incidence of oral squamous cell carcinoma (OSCCA) in OLP patients and have implicated OLP as a premalignant lesion. We describe five cases of OSCCA arising in patients with preexisting OLP. At our institution, the incidence of OSCCA in patients with OLP approximates that reported in other series. The immunopathologic basis for OLP, its potential association with malignancy, and the variable clinical picture of OSCCA in patients with OLP are reviewed. Specific recommendations are given for treatment and follow-up of lesions, including the role of future testing with viral and oncogene markers.
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Carcinoma de Células Escamosas/patología , Liquen Plano Oral/patología , Neoplasias de la Boca/patología , Lesiones Precancerosas , Anciano , Carcinoma de Células Escamosas/complicaciones , Progresión de la Enfermedad , Femenino , Humanos , Liquen Plano Oral/complicaciones , Liquen Plano Oral/inmunología , Persona de Mediana Edad , Neoplasias de la Boca/complicaciones , Lesiones Precancerosas/inmunología , Lesiones Precancerosas/patología , Estudios RetrospectivosRESUMEN
Many modern surgical techniques have been developed to provide exposure or visualization of the surgical field to perform definitive treatment. The actual therapeutic part of surgery is often a small fraction of the procedure. In obtaining exposure, however, morbidity can ensue. This has led to newer techniques that use minimally invasive treatments, thus substantially decreasing overall morbidity and patient costs. By providing physicians with visualization alternatives, MR imaging and computed tomography, when combined with a therapeutic procedure, can reduce the morbidity of surgery.
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Neoplasias de Cabeza y Cuello/cirugía , Cabeza/patología , Imagen por Resonancia Magnética , Cuello/patología , Tomografía Computarizada por Rayos X , Biopsia con Aguja/métodos , Ablación por Catéter , Cabeza/cirugía , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Terapia por Láser , Cuello/cirugíaRESUMEN
Positron emission tomography (PET) has recently proved to be highly sensitive in detecting known extracranial head and neck squamous cell carcinomas when compared to computed tomography and magnetic resonance imaging (MRI). The ability of PET to detect early subclinical recurrent squamous cell malignancies in patients who received primary radiotherapy was evaluated. A new PET-MRI coregistration technique was used to determine precise anatomic tumor location, enabling directed biopsies to confirm the presence of malignancy, and to plan additional therapeutic strategies. Ten patients underwent PET evaluation with intravenous [18F]-fluorodeoxyglucose and received postradiotherapy MRI scans. In all cases, PET accurately detected the presence of recurrent disease despite negative or equivocal MRI scans and indeterminate clinical examinations. PET appears to be highly effective in detecting early recurrent head and neck squamous cell malignancies in postirradiated patients.
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Carcinoma de Células Escamosas/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía Computarizada de Emisión , Adulto , Biopsia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/radioterapia , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Examen FísicoAsunto(s)
Obstrucción de las Vías Aéreas/etiología , Laringitis/complicaciones , Laringitis/microbiología , Laringe/microbiología , Streptococcus pyogenes/aislamiento & purificación , Anciano , Obstrucción de las Vías Aéreas/cirugía , Femenino , Humanos , Laringoscopía , Laringe/ultraestructura , TraqueotomíaRESUMEN
Merkel cell carcinoma (MCC) is an aggressive skin neoplasm of neuroendocrine origin. To clarify those factors important in improving survival, we retrospectively reviewed the charts of all patients with Merkel cell carcinoma treated at two tertiary referral centers. Eighty percent of the patients with stage I disease were initially treated with local therapy alone, while all of the patients with stage II disease were treated with local and regional therapy. The overall survival rate for all patients was 64%. Regardless of stage, patients treated with local excision alone had a 52% 5-year survival rate, while patients treated with local excision and lymph node dissection had an 87% survival rate. We conclude that the aggressive nature of this tumor warrants radical therapy.
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Carcinoma de Células de Merkel/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias de la Parótida/cirugía , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células de Merkel/mortalidad , Carcinoma de Células de Merkel/secundario , Femenino , Estudios de Seguimiento , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Neoplasias de la Parótida/mortalidad , Neoplasias de la Parótida/secundario , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/patología , Tasa de Supervivencia , Factores de TiempoRESUMEN
INTRODUCTION: This study was undertaken to elucidate the efficacy of external beam irradiation in the treatment of head and neck malignant melanoma, in comparison with the efficacy of surgical excision and the efficacy of surgical excision combined with external beam irradiation. MATERIALS AND METHODS: A retrospective chart review of all patients seen at the Department of Radiation Oncology at the University of California at Los Angeles Medical Center with the diagnosis of head and neck melanoma from 1973 to 1992 was conducted. Using chi 2 analysis, survival rates were examined for patients treated with excision alone, irradiation alone, and both excision and irradiation. RESULTS: Patients were treated with primary excision (96%), salvage excision for recurrent or residual disease (47%), primary irradiation (9%), post-surgical-planned irradiation (22%), adjuvant chemotherapy (45%), and adjuvant immunotherapy (36%). The overall survival rate for the entire group was 29%. For patients with recurrent or regional disease, survival rates were 37% for those treated with excision in combination with irradiation, 20% for those treated with irradiation alone, and 19% for those treated with excision. Whereas the differences among groups were not statistically significant, the biologic implication is that external beam irradiation is effective in controlling regional disease, since the tumors treated with irradiation alone or excision in combination with irradiation were larger and more aggressive than those treated with excision alone. CONCLUSION: External beam irradiation is of benefit in treating patients with melanoma who are ineligible for salvage surgery or as an adjunctive modality in situations where the risk of recurrence is high.