Evaluation of the prognostic significance of the site of origin of cutaneous melanoma.

The prognostic significance of the BANS region (Back, Arms, Neck, Scalp) in primary cutaneous melanoma remains controversial. We hypothesized that the different anatomic sites of the BANS region may have different prognostic significance. As the anatomic areas examined have varied between reports on BANS or head and neck melanomas, these differences could explain the lack of consistent findings. Between 1971-1990 more than 5000 patients with Stage I (n = 2576) and Stage II (n = 852) cutaneous melanoma were treated at the UCLA Medical Center. Patients were stratified for analysis into the following anatomic categories: scalp, neck, upper back, arm, and other anatomic sites. Initial analysis revealed that Clark's level of invasion, tumor thickness, gender, and number of positive nodes were predictive of survival. Controlling for these variables, the impact of the site of origin on prognosis was evaluated. Five-year actuarial survival in Stage I patients was as follows: scalp--80 per cent, neck--92 per cent, upper back--90 per cent, arm--94 per cent, all others--89 per cent. There were no significant survival differences between these groups, although the poorer survival for scalp primaries approached statistical significance (P = 0.084). In Stage II disease, however, marked survival differences were noted between anatomic sites. median survival for Stage II patients was as follows: scalp--25 months, neck--28 months, upper back--38 months, arm--75 months, all others--67 months (P = 0.005). These results indicate that anatomic site of origin does affect prognosis in patients with nodal metastases.