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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2013

01-09-2013 | Melanomas

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

Authors: Niloofar Fadaki, MD, Rui Li, PhD, Brian Parrett, MD, Grant Sanders, MD, Suresh Thummala, MD, Lea Martineau, RN, Servando Cardona-Huerta, MD, PhD, Suzette Miranda, MD, Shih-Tsung Cheng, MD, James R. Miller III, PhD, Mark Singer, MD, James E. Cleaver, PhD, Mohammed Kashani-Sabet, MD, Stanley P. L. Leong, MD, FACS

Published in: Annals of Surgical Oncology | Issue 9/2013

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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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Metadata
Title
Is Head and Neck Melanoma Different from Trunk and Extremity Melanomas with Respect to Sentinel Lymph Node Status and Clinical Outcome?
Authors
Niloofar Fadaki, MD
Rui Li, PhD
Brian Parrett, MD
Grant Sanders, MD
Suresh Thummala, MD
Lea Martineau, RN
Servando Cardona-Huerta, MD, PhD
Suzette Miranda, MD
Shih-Tsung Cheng, MD
James R. Miller III, PhD
Mark Singer, MD
James E. Cleaver, PhD
Mohammed Kashani-Sabet, MD
Stanley P. L. Leong, MD, FACS
Publication date
01-09-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 9/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-2977-7

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