Role of Postoperative Radiotherapy in the Management of Localized Head and Neck Mucosal Melanoma

Abstract

Background/Objectives: To evaluate the role of postoperative radiotherapy (PORT) in the management of localized head and neck mucosal melanoma (HNMM). Methods: We retrospectively reviewed 33 patients who underwent surgery for localized HNMM between 2006 and 2023. PORT was delivered to affected anatomical structures, and elective nodal irradiation was not performed. Treatment outcomes, including local recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS), were analyzed. Results: After surgery, 14 patients (41.4%) received PORT. During follow-up, 87.9% of patients experienced recurrence, with local and distant failures being the most common. PORT significantly improved LRFS (p = 0.047) but did not impact PFS or OS. PORT (HR 0.14, p = 0.005) and resection margin status (HR 8.71, p < 0.001) were significantly associated with LRFS in multivariable analysis. Conclusions: PORT for localized HNMM improved local control. Regional recurrence was rare (one patient, 3.4%) even though ENI was not performed. PORT without ENI could improve clinical outcomes for localized HNMM.