Annals of Surgical Oncology

, Volume 20, Issue 9, pp 3089–3097

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

  • Niloofar Fadaki
  • Rui Li
  • Brian Parrett
  • Grant Sanders
  • Suresh Thummala
  • Lea Martineau
  • Servando Cardona-Huerta
  • Suzette Miranda
  • Shih-Tsung Cheng
  • James R. MillerIII
  • Mark Singer
  • James E. Cleaver
  • Mohammed Kashani-Sabet
  • Stanley P. L. Leong
Melanomas

DOI: 10.1245/s10434-013-2977-7

Cite this article as:
Fadaki, N., Li, R., Parrett, B. et al. Ann Surg Oncol (2013) 20: 3089. doi:10.1245/s10434-013-2977-7

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.

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Niloofar Fadaki
    • 1
  • Rui Li
    • 2
  • Brian Parrett
    • 3
  • Grant Sanders
    • 4
  • Suresh Thummala
    • 1
  • Lea Martineau
    • 1
  • Servando Cardona-Huerta
    • 1
  • Suzette Miranda
    • 3
    • 4
  • Shih-Tsung Cheng
    • 1
  • James R. MillerIII
    • 1
  • Mark Singer
    • 1
    • 5
  • James E. Cleaver
    • 6
  • Mohammed Kashani-Sabet
    • 1
  • Stanley P. L. Leong
    • 1
    • 4
  1. 1.Center for Melanoma Research & TreatmentCalifornia Pacific Medical CenterSan FranciscoUSA
  2. 2.Novartis Molecular DiagnosticsCambridgeUSA
  3. 3.The Buncke ClinicCalifornia Pacific Medical CenterSan FranciscoUSA
  4. 4.Department of SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  5. 5.Department of Head and Neck SurgeryCalifornia Pacific Medical CenterSan FranciscoUSA
  6. 6.Department of DermatologyUniversity of California, San FranciscoSan FranciscoUSA