Of 336 patients with malignant melanoma of the head and neck treated at the Mayo Clinic, 265 were eligible for three year follow-up study and 224 were eligible for five year follow-up study. Treatment consisted of three surgical approaches: (1) simple excision, (2) excision of clinically positive regional nodes, and (3) wide excision of the primary lesion combined with elective neck dissection. For both the three and five year follow-up studies, the over-all survival rates for the total group averaged nearly 45 per cent. Once clinically positive nodes were detected, the survival rates decreased to less than half of this figure, whereas the rates for patients treated by prophylactic nodal dissection increased to 65 per cent at three years and 64 per cent at five years. It is possible that elective neck dissection removed some submicroscopic “seedlings” of metastatic tumor that were in an early temporal stage; thus, such removal may have given a significant advantage to some patients over the alternative of waiting for the seedlings to ripen to the clinically positive stage. Based on the finding of significantly increased survival rates with prophylactic nodal dissection, this modality is the treatment of choice for the patient with malignant melanoma of the head and neck.

One hundred and seven cases of mucoepidermoid carcinoma of major salivary glands (91 per cent in the parotid gland) encountered at the Mayo Clinic from 1907 through 1963 have been reviewed. Approximately two thirds of the patients were females and the age of patients ranged from five to eighty-one years. Tumors were divided on a histopathologic basis into three groups (grades 1, 2, and 3), representing different levels of histologic activity. In the earlier part of the period, excision of the tumor was the most common treatment; later subtotal or total removal of the gland was most frequently the treatment of choice. The recurrence rate for all tumors was 25 per cent, being 10 per cent for the well differentiated tumors (grades 1 and 2) and 71.4 per cent for the grade 3 lesions. The survival rate is excellent for patients with grade 1 and grade 2 lesions, but poor for those with grade 3 tumors. Total parotidectomy with preservation of the facial nerve in most cases is the treatment of choice for mucoepidermoid carcinoma in the parotid gland, and total removal of the gland when the lesion is located in the submaxillary or sublingual gland.

A brief historical review of chemodectoma of the carotid and aortic bodies is given. The anatomic location, embryologic development, and physiology of aortic bodies are described. A case of a chemodectoma of the aortic body presenting in the neck and successfully removed is reported. The patient is well and without recurrence five years later.

SIMONS, JOHN N. M.D. M.S.; ROBINSON, DAVID W. M.D., M.S.; MASTERS, FRANK W. M.D. Author Information

KAYE, BERNARD L. M.D., D.M.D.; ROBINSON, DAVID W. M.D., M.S.; MASTERS, FRANK W. M.D.; SIMONS, JOHN N. M.D., M.S. Author Information

Fourteen patients with a loss of function of the seventh nerve have undergone temporalis transfer operations for the resulting lagopthalmos. A detailed description of the operation is given. Ten of the fourteen patients have had good or excellent results. The preservation of all other normally functioning cranial nerves and the dynamic nature of this procedure combined with its low morbidity have led the authors to believe that temporalis transfer is the preferred method of repair of lagopthalmos resulting from seventh nerve palsy.

1.1. Cervical thymic cyst is a rare lesion resulting from degeneration of ectopic thymic tissue.2.2. The embryology, clinical characteristics and pathologic findings have been reviewed.3.3. The frequent reports of such cases since 1960 suggest that previously unreported cases have been erroneously diagnosed as branchial cleft cyst.

Study of 128 cases of neoplasms of the submaxillary gland in which operation was performed at the Mayo Clinic from 1936 through 1955 with careful attention to classification of the lesions and comparison of findings in the literature on other salivary tumors yielded the following observations and conclusions. 1.1. Benign mixed tumor is the most common tumor found in the submaxillary gland. Its predominance, however, is less than in the parotid gland.2.2. Cylindroma is the most common malignant tumor in the submaxillary gland and is relatively more common in the submaxillary gland than in the parotid gland.3.3. Benign tumors of the submaxillary gland are found in younger patients than are malignant tumors.4.4. Benign tumors tend to be smaller, more stationary in size, give less pain and show less tendency to local invasion than do malignant tumors.5.5. Both benign and malignant tumors, that later recur, begin at an earlier age than tumors that do not recur.6.6. Removal of the entire submaxillary gland with the tumor is the treatment of choice for all benign tumors and well encapsulated malignant tumors. More radical surgical procedures are preferable for locally invasive malignant tumors.7.7. Recurrence is rare after surgical treatment of benign tumors of the submaxillary gland.8.8. Following adequate surgical treatment, approximately half of the patients with malignant tumors of the submaxillary gland will live five years without evidence of recurrence.9.9. Recurrence may develop in patients with cylindroma more than five years postoperatively, but a ten year follow-up without recurrence should be synonomous with cure.

The records of 150 patients treated with combined operations for intraoral cancers were reviewed with emphasis on correlation between prognosis and age, presence or absence of histologically positive nodes, grade of neoplasm, and previous treatment. The three year survival rate was 48 per cent and the five year survival rate was 40 per cent. Of those patients succumbing with uncontrolled local disease, 89 per cent died in less than three years after operation. The close agreement of the three year and five year survival rates, together with the high percentage of deaths from the disease within three years, suggests that three year survival rates are as reliable as five year survival rates in this disease. Survival rates were significantly less than the over-all average for patients in the following categories: patients less than fifty years of age, patients having histologically proved metastatic involvement of lymph nodes, patients having higher grade tumors, and patients who had had previous roentgen therapy to the primary lesion. Mortality and morbidity were not excessive and deformity was surprisingly minimal. If, in the future, the surgeon can proceed with radical surgery at an earlier stage in the disease, even more promising survival rates may be attained.