BACKGROUND: Outcomes are thought to be worse in head and neck (H&N) melanoma patients. However, definitive evidence of inferior outcomes in H&N melanoma in the modern era is lacking. We sought to ascertain whether H&N melanomas carry a worse prognosis than melanomas of other sites. METHODS: All patients who underwent excision for primary melanoma by fellowship-trained surgical oncologists at a single institution from 2014 to 2020 were queried from the electronic medical record. Patients who had AJCC eighth edition stage I-III disease were included. RESULTS: Of 1127 patients, 28.7% had primary H&N melanoma. H&N patients were more likely to be male, older, and present with more advanced AJCC stage. Median follow-up was 20.0 months (IQR 26.4). On multivariable analyses controlling for other variables, H&N melanoma was associated with worse RFS. Notably, H&N melanoma was not associated with worse MSS, DMFS, or OS on univariate or multivariable analyses. Among patients who recurred, H&N patients were significantly more likely to recur locally compared to non-H&N patients. On subgroup analysis, scalp melanoma was also associated with worse RFS compared to patients with melanoma in locations other than the scalp. When patients with scalp melanoma were excluded from analysis, non-scalp H&N RFS was not significantly different from the non-H&N group on univariate or multivariable analyses. DISCUSSION: In this series from a high-volume tertiary referral center, the differences in rates and sites of recurrence between H&N and non-H&N melanoma do not impact melanoma-specific or overall survival, suggesting that H&N melanoma patients should be treated similarly with respect to regional and systemic therapies.
BACKGROUND: Outcomes are thought to be worse in head and neck (H&N) melanoma patients. However, definitive evidence of inferior outcomes in H&N melanoma in the modern era is lacking. We sought to ascertain whether H&N melanomas carry a worse prognosis than melanomas of other sites. METHODS: All patients who underwent excision for primary melanoma by fellowship-trained surgical oncologists at a single institution from 2014 to 2020 were queried from the electronic medical record. Patients who had AJCC eighth edition stage I-III disease were included. RESULTS: Of 1127 patients, 28.7% had primary H&N melanoma. H&N patients were more likely to be male, older, and present with more advanced AJCC stage. Median follow-up was 20.0 months (IQR 26.4). On multivariable analyses controlling for other variables, H&N melanoma was associated with worse RFS. Notably, H&N melanoma was not associated with worse MSS, DMFS, or OS on univariate or multivariable analyses. Among patients who recurred, H&N patients were significantly more likely to recur locally compared to non-H&N patients. On subgroup analysis, scalp melanoma was also associated with worse RFS compared to patients with melanoma in locations other than the scalp. When patients with scalp melanoma were excluded from analysis, non-scalp H&N RFS was not significantly different from the non-H&N group on univariate or multivariable analyses. DISCUSSION: In this series from a high-volume tertiary referral center, the differences in rates and sites of recurrence between H&N and non-H&N melanoma do not impact melanoma-specific or overall survival, suggesting that H&N melanoma patients should be treated similarly with respect to regional and systemic therapies.
Authors: Mark B Faries; John F Thompson; Alistair J Cochran; Robert H Andtbacka; Nicola Mozzillo; Jonathan S Zager; Tiina Jahkola; Tawnya L Bowles; Alessandro Testori; Peter D Beitsch; Harald J Hoekstra; Marc Moncrieff; Christian Ingvar; Michel W J M Wouters; Michael S Sabel; Edward A Levine; Doreen Agnese; Michael Henderson; Reinhard Dummer; Carlo R Rossi; Rogerio I Neves; Steven D Trocha; Frances Wright; David R Byrd; Maurice Matter; Eddy Hsueh; Alastair MacKenzie-Ross; Douglas B Johnson; Patrick Terheyden; Adam C Berger; Tara L Huston; Jeffrey D Wayne; B Mark Smithers; Heather B Neuman; Schlomo Schneebaum; Jeffrey E Gershenwald; Charlotte E Ariyan; Darius C Desai; Lisa Jacobs; Kelly M McMasters; Anja Gesierich; Peter Hersey; Steven D Bines; John M Kane; Richard J Barth; Gregory McKinnon; Jeffrey M Farma; Erwin Schultz; Sergi Vidal-Sicart; Richard A Hoefer; James M Lewis; Randall Scheri; Mark C Kelley; Omgo E Nieweg; R Dirk Noyes; Dave S B Hoon; He-Jing Wang; David A Elashoff; Robert M Elashoff Journal: N Engl J Med Date: 2017-06-08 Impact factor: 91.245
Authors: B Passmore-Webb; B Gurney; H M Yuen; J Sloane; J Lee; M Proctor; F Sundram; C Newlands; S Sharma Journal: Br J Oral Maxillofac Surg Date: 2019-08-26 Impact factor: 1.651
Authors: D Evrard; E Routier; C Mateus; G Tomasic; J Lombroso; F Kolb; C Robert; A Moya-Plana Journal: Eur Arch Otorhinolaryngol Date: 2018-03-19 Impact factor: 2.503
Authors: Benjamin E Saltman; Ian Ganly; Snehal G Patel; Daniel G Coit; Mary Sue Brady; Richard J Wong; Jay O Boyle; Bhuvanesh Singh; Ashok R Shaha; Jatin P Shah; Dennis H Kraus Journal: Head Neck Date: 2010-12 Impact factor: 3.147
Authors: David S Sparks; Tavis Read; Michael Lonne; Andrew P Barbour; Michael Wagels; Gerard J Bayley; B Mark Smithers Journal: J Surg Oncol Date: 2016-12-30 Impact factor: 3.454
Authors: John E Hanks; Kevin J Kovatch; S Ahmed Ali; Emily Roberts; Alison B Durham; Joshua D Smith; Carol R Bradford; Kelly M Malloy; Philip S Boonstra; Christopher D Lao; Scott A McLean Journal: Otolaryngol Head Neck Surg Date: 2020-02-11 Impact factor: 3.497