Cutaneous malignant melanoma of the head and neck. Analysis of treatment results and prognostic factors in 581 patients: A report from the swedish melanoma study group

Abstract

Background. Results of surgical treatment of cutaneous malignant melanoma (CMM) have been highly variable, probably because of patient selection. Therefore, a study of representative patients with this disease was performed. Methods. In a defined area of Sweden, 581 patients were analyzed. Clinical records and histopathologic findings were reviewed. The minimum follow‐up time was 7 years. Prognostic factors were evaluated by the Cox proportional hazards model. Results. Evaluation of sex distribution, age, and anatomic site of the primary tumor showed that the patients were representative of all Swedish patients with CMM of the head and neck. The mean patient age at diagnosis was 64 years for both sexes. Fifty‐three percent of the patients were women. Female patients had more tumors of the face than did male patients, whereas male patients were overrepresented among patients with tumors of the auricle‐external ear canal and scalp‐neck area. Localization to the face was observed in 68%, which is an overrepresentation of three to four times when skin surface is taken into consideration. Twenty‐four percent of the patients had lentigo maligna melanoma. Only 33% of the patients had superficial spreading melanoma. In univariate analyses, sex, anatomic site of the primary tumor, histogenetic type, Clark level of invasion, and tumor thickness had prognostic power. In a multivariate analysis, tumor thickness, anatomic site of the primary tumor, and sex of the patient were independent prognostic factors. Conclusions. In representative patients with CMM of the head and neck, tumor thickness, anatomic site of the primary tumor, and sex of the patients were independent prognostic factors.

Dermoscopic features of melanoma on the scalp

“…2,3 This fact indicates that there is a need to improve the early detection of melanoma on this specific location. Dermoscopy was shown to be a useful tool in the evaluation of pigmented skin lesions and particularly in the early detection of melanoma.…”

Adherence to guideline excision margins in head and neck melanoma: the influence on 5-year survival and loco-regional recurrence

“…Quoted 5-year survival figures for head and neck melanoma include 65%, 70%, 77%, 82%, 85% and 85% [5,7,10,23,[26][27][28], and quoted loco-regional recurrence rates include 12%, 15%, 19%, 20%, 23% and 27% [2,4,5,26,28,29]. Direct comparison between different studies however is hindered by variations in Breslow thickness for the different cohort populations [6,7,21,23,26,28,29].…”

“…Within the head and neck region, various studies have reported scalp location as a significant indicator of adverse survival and recurrence [4][5][6][7]10]. This is partly attributed to the increased Breslow thickness and increased rate of ulceration that is associated with this tumour type [2,6,29].…”

“…Head and neck melanoma accounts for 10-25% of this disease [1][2][3][4][5]. The incidence of this type of melanoma has risen rapidly: in men, it has increased from 0.9 per 100,000 in 1979-1983 to 2.8 per 100,000 in 1999-2003; in women, it has increased from 0.8 per 100,000 in 1979-1983 to 1.8 per 100,000 in 1999-2003 [1].…”

Cutaneous malignant melanoma of the head and neck: the role of planned definitive surgery

“…Although surgical treatment is still the main therapy for these tumors, the reported results have been highly variable mainly because of the patient selection [21]. The specific cosmetic and functional problems with this type of surgery led to various guidelines and attitudes in terms of surgical margins and in cervical lymph node management [1,17,22,29]. Nevertheless, patients who received adequate and scheduled surgical treatment of their primary melanoma lesions are often cured [15].…”