Scalp melanoma: Distinctive high risk clinical and histological features

Xie, Charles; Pan, Yue; McLean, Catriona; Mar, Victoria; Wolfe, Rory; Kelly, John W.

doi:10.1111/ajd.12437

Cited by 44 publications

(67 citation statements)

References 28 publications

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“…Our patient cohort was predominantly an aged male group with high risk primary features including a median Breslow thickness of 2.5 mm with ulceration in 29.1% (Table ). This is consistent with other studies in the literature evaluating the demographic and clinicopathologic patterns of scalp melanoma . The recurrence patterns included a local recurrence rate 15.9%, ITM rate of 11.2%, regional nodal metastasis rate 12.1%, and a systemic metastasis rate of 15% with a DFS and all‐cause OS both 47% at 30.5 months median follow‐up.…”

Section: Discussionsupporting

confidence: 89%

Primary cutaneous melanoma of the scalp: Patterns of recurrence

Sparks

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Lonne

et al. 2016

Journal of Surgical Oncology

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Section: Discussionsupporting

confidence: 89%

Primary cutaneous melanoma of the scalp: Patterns of recurrence

Sparks

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Lonne

et al. 2016

Journal of Surgical Oncology

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“…In our study, most patients with fatal scalp tumours were older men, consistent with findings of male pattern baldness being strongly associated with melanomas at this site . Moreover, scalp lesions can be difficult to detect as they are more likely to be amelanotic than other head and neck sites . Our findings highlight that thin melanomas located on the scalp are of higher risk than other thin tumours, and that scalp lesions require close follow‐up after initial diagnosis and management.…”

Section: Discussionsupporting

confidence: 86%

Clinicopathological factors associated with death from thin (≤ 1·00 mm) melanoma

et al. 2019

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Summary Background Thin cutaneous melanomas (≤ 1·00 mm) are increasing worldwide, causing around a quarter of all melanoma deaths in the U.S.A. and Australia. Identification of predictive factors for potentially fatal thin melanomas could allow better use of resources for follow‐up. Objectives To identify the clinicopathological factors associated with fatal thin melanomas. Methods This large, nested case–case study extracted data from the population‐based Queensland Cancer Registry, Australia. Our cohort consisted of Queensland residents aged 0–89 years who were diagnosed with a single, locally invasive thin melanoma (≤ 1·00 mm) between 1995 and 2014. Fatal cases (eligible patients who died from melanoma) were individually matched to three nonfatal cases (eligible patients who were not known to have died from melanoma) according to sex, age, year of diagnosis and follow‐up interval. Using conditional logistic regression, we calculated odds ratios (ORs) for melanoma‐specific death, adjusting for all collected clinicopathological variables. Results In the cohort, 27 660 eligible patients were diagnosed with a single, thin melanoma. The final case–case series included 424 fatal cases and 1189 nonfatal cases. Fatal cases were sixfold as likely to arise on the scalp as on the back [OR 6·39, 95% confidence interval (CI) 2·57–15·92] and six times as likely to be of thickness 0·80–1·00 mm as of < 0·30 mm (OR 6·00, 95% CI 3·55–10·17). Conclusions Scalp location is a strong prognostic factor of death from thin melanoma. Further, this study provides support that melanomas with a thickness of 0·80–1·00 mm are the more hazardous thin lesions. Patients with these tumour characteristics require specific attention during follow‐up. What's already known about this topic? Thin invasive melanomas (≤ 1·00 mm) contribute a substantial proportion of melanoma fatalities, owing to the high volume of disease. There is a need to find prognostic factors that will better identify fatal thin melanomas at the time of diagnosis. What does this study add? In this large population‐based study, fatal thin tumours were sixfold as likely to be located on the scalp as on the back. Thin melanomas of 0·80–1·00 mm thickness were six times as likely to be associated with death as tumours < 0·30 mm. Scalp location and increasing thickness are strong predictive factors of fatal thin melanomas, indicating that patients with these tumour characteristics require close follow‐up.

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“…Scalp melanomas, while considered the only site-specific melanoma to be associated with increased mortality, can be neglected and delayed in diagnosis due to the lack of visibility under hair [1]. Although giant scalp melanomas are treated with surgery, their size can pose significant difficulties in scalp reconstruction, especially if they require deep excision and the patient has comorbid medical conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Scalp melanomas currently comprise 3–5% of all cutaneous melanomas, with higher recurrence and mortality [1], [2]. They tend to occur in older men, usually with a history of solar keratosis, and are often amelanotic and rapidly growing [1].…”

Section: Introductionmentioning

confidence: 99%