What to do in level 4 node involvement in malignant melanoma
Patient: I have a patient aged 49 years with mucoal primaries. in tongue (Malignant Melanoma). No neck nodes initially N So, Hemiglossectomy done  and level 1, 2 and 3 nodes removed biopsy negative.  Nodes  After one year level 4 node involved. Radical Neck dissection done. What is the future course of action. Doctor: Malignant melanoma of the tongue is a rare and aggressive cancer that has the tendency to come back and spread. Your treatment so far appears to have been correct and scientific. My only concern is to rule out that the cancer has not spread to other parts of the body. For this, a PET scan will be ideal as it will scan the whole body. If it has not spread then there is no further treatment needed except close follow up with an oncosurgeon.