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Is Head and Neck Melanoma Different from Trunk and Extremity Melanomas with Respect to Sentinel Lymph Node Status and Clinical Outcome?

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Previous studies showed conflicting and inconsistent results regarding the effect of anatomic location of the melanoma on sentinel lymph node (SLN) positivity and/or survival. This study was conducted to evaluate and compare the effect of the anatomic locations of primary melanoma on long-term clinical outcomes.

Methods

All consecutive cutaneous melanoma patients (n = 2,079) who underwent selective SLN dissection (SLND) from 1993 to 2009 in a single academic tertiary-care medical center were included. SLN positive rate, disease-free survival (DFS), and overall survival (OS) were determined. Kaplan-Meier survival, univariate, and multivariate analyses were performed to determine predictive factors for SLN status, DFS, and OS.

Results

Head and neck melanoma (HNM) had the lowest SLN-positive rate at 10.8 % (16.8 % for extremity and 19.3 % for trunk; P = 0.002) but had the worst 5-year DFS (P < 0.0001) and 5-year OS (P < 0.0001) compared with other sites. Tumor thickness (P < 0.001), ulceration (P < 0.001), HNM location (P = 0.001), mitotic rate (P < 0.001), and decreasing age (P < 0.001) were independent predictive factors for SLN-positivity. HNM with T3 or T4 thickness had significantly lower SLN positive rate compared with other locations (P ≤ 0.05). Also, on multivariate analysis, HNM location versus other anatomic sites was independently predictive of decreased DFS and OS (P < 0.001). By Kaplan-Meier analysis, HNM was associated significantly with the worst DFS and OS.

Conclusions

Primary melanoma anatomic location is an independent predictor of SLN status and survival. Although HNM has a decreased SLN-positivity rate, it shows a significantly increased risk of recurrence and death as compared with other sites.

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Acknowledgment

Dr. Cleaver is supported by “E.A. Dickson Emeritus Professorship.” Dr. Servando Cardona-Huerta is a visiting professor supported by a scholarship from the Consorcio de Universidades Mexicanas (CuMEX) and the Universidad Autonoma de Nuevo Leon, Mex. Dr. Shih-Tsung Cheng is a visiting scholar sponsored by Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. There is no research support or disclaimers to acknowledge.

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Authors and Affiliations

  1. Center for Melanoma Research & Treatment, California Pacific Medical Center, San Francisco, CA, USA

    Niloofar Fadaki MD, Suresh Thummala MD, Lea Martineau RN, Servando Cardona-Huerta MD, PhD, Shih-Tsung Cheng MD, James R. Miller III PhD, Mark Singer MD, Mohammed Kashani-Sabet MD & Stanley P. L. Leong MD, FACS

  2. Novartis Molecular Diagnostics, Cambridge, MA, USA

    Rui Li PhD

  3. The Buncke Clinic, California Pacific Medical Center, San Francisco, CA, USA

    Brian Parrett MD & Suzette Miranda MD

  4. Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Grant Sanders MD, Suzette Miranda MD & Stanley P. L. Leong MD, FACS

  5. Department of Head and Neck Surgery, California Pacific Medical Center, San Francisco, CA, USA

    Mark Singer MD

  6. Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA

    James E. Cleaver PhD

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  1. Niloofar Fadaki MD
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  2. Rui Li PhD
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  13. Mohammed Kashani-Sabet MD
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  14. Stanley P. L. Leong MD, FACS
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Correspondence to Stanley P. L. Leong MD, FACS.

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Fadaki, N., Li, R., Parrett, B. et al. Is Head and Neck Melanoma Different from Trunk and Extremity Melanomas with Respect to Sentinel Lymph Node Status and Clinical Outcome?. Ann Surg Oncol 20, 3089–3097 (2013). https://doi.org/10.1245/s10434-013-2977-7

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