Annals of Surgical Oncology

, Volume 20, Issue 13, pp 4362–4369

Undertreatment of Thick Head and Neck Melanomas: An Age-based Analysis

  • Marcus M. Monroe
  • Jeffrey N. Myers
  • Michael E. Kupferman
Melanomas

DOI: 10.1245/s10434-013-3160-x

Cite this article as:
Monroe, M.M., Myers, J.N. & Kupferman, M.E. Ann Surg Oncol (2013) 20: 4362. doi:10.1245/s10434-013-3160-x

Abstract

Purpose

To determine U.S. treatment patterns for pathologic staging practices in patients with thick head and neck melanomas (HNM).

Methods

Patients with thick HNM without clinical evidence of in-transit, regional, or distant metastatic spread at presentation were identified from the Surveillance Epidemiology and End Results database. Treatment trends for patients were summarized, and univariate and multivariate analyses were performed to identify associations between varying practice patterns.

Results

A total of 1,230 patients with HNM meeting the inclusion criteria were identified. Surgical staging procedures were utilized in 53.5 %, including both sentinel lymph node biopsy (37 %) and elective neck dissection (16 %). Patients undergoing a surgical staging procedure were younger (64 vs. 77 years, p < 0.001) with smaller tumors (6.3 vs. 6.6 mm, p = 0.008). The rate of occult nodal disease was 22 % in patients undergoing a surgical staging procedure. The presence of a positive regional node in this subgroup of patients was associated with a significant reduction in disease-specific (44 vs. 59 months, p < 0.001) and overall survival (40 vs. 53 months, p < 0.001) on univariate analysis. On multivariate analysis, the presence of a positive node was the most significant factor for reduced overall survival (hazard ratio 2.36, 95 % confidence interval 1.71–3.23) and disease-specific survival (hazard ratio 2.84, 95 % confidence interval 1.99–4.06).

Conclusions

Pathologic staging procedures provide independent prognostic information for patients with thick HNM. Despite this, current practice patterns demonstrate underutilization, particularly in elderly patients. Further work is needed to address the barriers to pathologic staging implementation in patients with thick HNM.

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Marcus M. Monroe
    • 1
  • Jeffrey N. Myers
    • 1
  • Michael E. Kupferman
    • 1
  1. 1.Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA