Cutaneous head and neck melanoma: the old and the new

Rigual, Néstor R.; Popat, Saurin R.; Jayaprakash, Vijay; Jaggernauth, Wainwright; Wong, Michael K.

doi:10.1586/14737140.8.3.403

Cited by 15 publications

(5 citation statements)

References 76 publications

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“…Characteristics of our patient population are comparable to those found in the literature; frequency of H&N cutaneous melanoma is typically reported as between 20 and 30% of all cutaneous melanomas, 9,12-14 although some papers and series report lower frequencies. [15][16][17] Demographics associated with H&N location were also similar to published findings, with H&N melanomas being more frequently associated with male sex and older age. 9,18 Investigations of histopathologic subtypes of H&N melanoma compared to melanoma of other sites have not revealed any evidence to suggest that H&N melanoma is a biologically distinct entity.…”

Section: Discussionsupporting

confidence: 87%

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience

Baecher

Turgeon

Medin

et al. 2021

The American Surgeon™

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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.

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Section: Discussionsupporting

confidence: 87%

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience

Baecher

Turgeon

Medin

et al. 2021

The American Surgeon™

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“…Additionally, many patients have already undergone complex reconstructions with tissue rearrangement at time of presentation. These factors collectively make evaluation of patients with incompletely excised LM/LMM challenging …”

Section: Introductionmentioning

confidence: 99%

Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy

Navarrete‐Dechent

Aleissa

Córdova

et al. 2020

Acad Dermatol Venereol

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Background Lentigo maligna/lentigo maligna melanoma (LM/LMM) poses a treatment and surgical challenge given unpredictable subclinical extension resulting in incomplete excision. Objectives To describe the demographic, clinical and pathologic characteristics of incompletely excised LM/LMM. To evaluate the potential role of reflectance confocal microscopy (RCM). Patients and methods A retrospective review of a melanoma database at a tertiary cancer centre for patients referred with 'incompletely excised LM/LMM' or 'incompletely excised melanoma' between October 2006 and July 2017. We recorded clinical and pathological data and surgical margins needed to clear the residual LM/LMM. The second part consisted of a prospective cohort of patients in which RCM was performed when presenting with incompletely excised LM/LMM. Results We included a total of 67 patients (retrospective + prospective cohort); mean age was 64.9 (standard deviation: 11.3) years and 52.2% were males. For the retrospective cohort (n = 53), the mean scar size was 3.4 cm. The average initial margins excised prior to presentation were 4.8 mm (range 3-7 mm). The average additional margin needed to clear the residual, incompletely excised LM/LMM was 7.8 mm. For the prospective cohort (n = 14), there were no differences in age, gender or size when compared to the retrospective cohort. RCM had a diagnostic accuracy of 78.6%, a sensitivity of 90.9%, a specificity of 33.3% and a positive predictive value of 83.3% for the detection of incompletely excised LM/LMM. Conclusions Incompletely excised LM/LMM is a poorly characterized clinical-pathological scenario that may require considerable extra margins for microscopic clearance. RCM may emerge as a valuable tool for the evaluation of patients with incompletely excised LM/LMM.

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“…Although surgery is effective in early melanoma stages, high resistance of melanoma cells to chemo- and radiation therapy compromises post-surgical efforts that prevent recurrence in metastatic disease (Fecher and Flaherty 2009, Rigual et al 2008, Soengas and Lowe 2003). Adjuvant therapy with a recombinant version of endogenous cytokine IFNα is one of the few FDA-approved treatments (Ascierto and Kirkwood 2008, Kaehler et al 2010, Yao et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Inflammatory signaling compromises cell responses to interferon alpha

et al. 2011

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Interferon alpha (IFNα) is widely used for treatment of melanoma and certain other malignancies. This cytokine as well as the related IFNβ exerts potent anti-tumorigenic effects; however, their efficacy in patients is often suboptimal. Here we report that inflammatory signaling impedes the effects of IFNα/β. Melanoma cells can secrete pro-inflammatory cytokines that inhibit cellular responses to IFNα/β via activating the ligand-independent pathway for the phosphorylation and subsequent ubiquitination and accelerated degradation of the IFNAR1 chain of Type I IFN receptor. Catalytic activity of the p38 protein kinase was required for IFNAR1 downregulation and inhibition of IFNα/β signaling induced by proinflammatory cytokines such as Interleukin 1 (IL-1). Activation of p38 kinase inversely correlated with protein levels of IFNAR1 in clinical melanoma specimens. Inhibition of p38 kinase augmented the inhibitory effects of IFNα/β on cell viability and growth in vitro and in vivo. The role of inflammation and p38 protein kinase in regulating cellular responses to IFNα/β in normal and tumor cells are discussed.

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Cutaneous head and neck melanoma: the old and the new

Cited by 15 publications

References 76 publications

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience

Incompletely excised lentigo maligna melanoma is associated with unpredictable residual disease: clinical features and the emerging role of reflectance confocal microscopy

Inflammatory signaling compromises cell responses to interferon alpha

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