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Lallas K, Kyrgidis A, Chrysostomidis A, Vakirlis E, Apalla Z, Lallas A. Clinical, dermatoscopic, histological and molecular predictive factors of distant melanoma metastasis: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024:104458. [PMID: 39074631 DOI: 10.1016/j.critrevonc.2024.104458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Melanoma metastasis to distant sites is associated with diminished survival rates and poor prognosis. Except of Breslow thickness and ulceration that are currently used in melanoma staging, the investigation of additional clinicopathological, dermatoscopic and molecular factors that could predict tumors with aggressive biologic behavior is of paramount importance. METHODS A literature search was conducted in PubMed, Scopus, Cochrane databases and grey literature until November 2023. Observational studies (including cohorts and case-control studies) were included and clinical and histopathological factors of primary cutaneous melanomas, along with dermatoscopic and molecular predictors of distant metastasis (DM) and distant metastasis-free survival (DMFS) were assessed. Random - effect models were preferred, the results were presented as Hazard Ratios (HRs) with 95%Confidence Intervals (CIs) and the I2 index quantified heterogeneity. Subgroup analysis according to AJCC stage and sensitivity analysis were also conducted. RESULTS One hundred forty-three and 101 studies were included in the qualitive and quantitative synthesis, respectively. Regarding clinical factors, males, compared to females, and head and neck location, compared to trunk, demonstrated higher risk for DM [n=36, HR 1.49, 95%CI 1.36 - 1.63, I2 33% and n=21, HR 1.24, 95%CI 1.01 - 1.52, I2 62%]. Both factors had similar effects on DMFS. Breslow thickness and ulceration were significant predictors or DM. Additional factors that posed an increased risk for DM were nodular (n=15, HR 2.51, 95%CI 1.83 - 3.43, I2 56%) and lentigo maligna subtypes (n=12, HR 1.87, 95%CI 1.27 - 2.75, I2 0%), compared to superficial spreading subtype, lymphovascular invasion (n=9, HR 2.05, 95%CI 1.18 - 3.58, I2 78%), SLN positivity and BRAF+ mutational status. In contrast, regression was a negative predictor of DM (n=15, HR 0.59, 95%CI 0.44 - 0.79, I2 68%). Two studies focused on dermatoscopic factors and found that low pigmentation and the presence of blue-white veil might predict DM development. The results of subgroup analysis for stage I-II patients were essentially similar and sensitivity analysis did not reveal significant alterations, despite the moderate or high heterogeneity in some categories. CONCLUSIONS Clinical and histological characteristics of the tumor along with dermatoscopic features and molecular parameters hold significant prognostic information and could be incorporated into models to predict melanomas with high metastatic potential.
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Affiliation(s)
- Konstantinos Lallas
- Department of Medical Oncology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece.
| | - Athanassios Kyrgidis
- Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Anestis Chrysostomidis
- Oral and Maxillofacial Surgery, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Zoe Apalla
- Second Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
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Yoo H, Park S, Kim SW. Nodular type predominance of head and neck cutaneous malignant melanoma in Asian populations leads to poor outcome and low survival. Melanoma Res 2023; 33:326-331. [PMID: 37199704 DOI: 10.1097/cmr.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Cutaneous malignant melanomas of the head and neck (HNM) are proposed to have notable histological and clinical differences from those at other sites (other melanoma); however, HNMs among Asians have remained poorly understood. This study aimed to investigate the clinicopathological features and prognostic factors of HNM in Asians. Asian melanoma patients who underwent surgical treatment from January 2003 to December 2020 were retrospectively reviewed. The clinicopathological features and risk factors for local recurrence, lymph node metastasis, and distant metastasis were analyzed. Among 230 patients, 28 (12.2%) were diagnosed with HNM, and 202 (87.8%) with other melanoma. The histologic subtype significantly differed as the nodular type was predominant in HNM whereas the acral lentiginous type was predominant in other melanoma ( P < 0.001). HNM was significantly associated with higher local recurrence ( P = 0.045), lymph node metastasis ( P = 0.048), distant metastasis ( P = 0.023), and lower 5-year disease-free survival ( P = 0.022) than other melanoma. Ulceration was the risk factor for lymph node metastasis based on multivariable analysis ( P = 0.013). A high proportion of HNM present as the nodular subtype in Asians, leading to poor outcomes and low survival. Therefore, more cautious surveillance, evaluation, and aggressive treatment are required.
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Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Cabrera CI, Li S, Conic R, Gastman BR. The National Cancer Database: Survival Between Head and Neck Melanoma and Melanoma of Other Regions. Otolaryngol Head Neck Surg 2021; 167:286-297. [PMID: 34699278 DOI: 10.1177/01945998211053204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Primary site is considered an important prognostic factor for cutaneous malignant melanoma (CMM); however, opinions vary regarding its influence on survival. This study compares overall survival between head and neck melanoma (HNM) and melanoma of other regions (MOR), as well as between melanoma of the scalp and neck (MSN) and melanoma of other head regions (MOHR). STUDY DESIGN Level III retrospective cohort study. SETTING Patients from Commission on Cancer-accredited cancer programs affiliated to the National Cancer Database (NCDB). METHODS Patients with HNM (MSN and MOHR included) and MOR, stages I to IV (n = 39,754), and their linked survival data using the NCDB were identified. Survival was analyzed using propensity score matching methods. RESULTS After matching using propensity scores, allowing this observational study to mimic a randomized controlled trial, subjects with HNM showed a 22% increased mortality when compared to MOR (P < .01). Among those with HNM, hazard was not proportional over time. Overall, subjects with MSN in the first 3.5 years of follow-up (75% of subjects) showed a 15% increased mortality when compared to MOHR (P < .01); however, after 3.5 years, no difference in survival was noted (P = .5). CONCLUSION Patients with HNM showed a higher mortality when compared to MOR. The risk of death of primary sites within the head and neck varies over time, showing a higher risk of mortality for scalp and neck during the first 3.5 years of follow-up. This increased risk was not evident after the 3.5-year threshold. Further research is needed to evaluate additional patient factors or differences in treatment approaches.
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Affiliation(s)
- Claudia I Cabrera
- Department of Otolaryngology-Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Shawn Li
- Department of Otolaryngology-Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rosalynn Conic
- University of Maryland Medical Center, Department of Surgery, Baltimore, Maryland, USA
| | - Brian R Gastman
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Echanique KA, Ghazizadeh S, Moon A, Kwan K, Pellionisz PA, Rünger D, Elashoff D, St. John M. Head & neck melanoma: A 22-year experience of recurrence following sentinel lymph node biopsy. Laryngoscope Investig Otolaryngol 2021; 6:738-746. [PMID: 34401498 PMCID: PMC8356881 DOI: 10.1002/lio2.605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/25/2021] [Accepted: 06/10/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To examine the clinicopathologic factors that contribute to regional and distant recurrence in intermediate to high risk head and neck melanoma patients after sentinel lymph node biopsy (SLNB). METHODS This study is a retrospective review from an academic tertiary care center. Patients treated with SLNB for head and neck melanoma from 1997 to 2019 were reviewed and characterized by sentinel lymph node (SLN) status. Clinical variables were examined for the impact on regional and distant recurrence in SLNB-negative patients using univariable and multivariable Cox regression analysis. RESULTS One hundred and fifty four patients were included. Of note, 127 (82.5 %) were men, and the average age was 61.3 years. Median follow-up was 68.6 weeks. Pathologic review of SLNs found 3.9% positive for metastatic melanoma; 96.1% were negative. Regional recurrence was significantly associated with tumor stage and age on multivariate analysis. A total of 4.5% of patients recurred in a previously labeled negative basin. Scalp subsite accounted for 30.5% of primary tumors and was more likely to yield a positive SLN on univariate analysis (P = .023). Tumor stage and age were significantly associated with distant metastasis on multivariable analysis (P = .026, P < .001 respectively). CONCLUSION We report a number of prognostic trends in head and neck melanoma. SLN positivity was found more often in patients with a primary tumor of the scalp. Regional recurrence was significantly associated with age and tumor stage, whereas distant recurrence was significantly associated with tumor staging and scalp subsite. Scalp subsite was associated with an increased risk for nodal metastasis and distant recurrence. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Kristen A. Echanique
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California Los AngelesLos Angeles, CaliforniaUSA
| | - Shabnam Ghazizadeh
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California Los AngelesLos Angeles, CaliforniaUSA
| | - Andy Moon
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California Los AngelesLos Angeles, CaliforniaUSA
| | - Kera Kwan
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California Los AngelesLos Angeles, CaliforniaUSA
| | - Peter A. Pellionisz
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California Los AngelesLos Angeles, CaliforniaUSA
| | - Dennis Rünger
- Department of Medicine Statistics CoreUniversity of California Los AngelesLos Angeles, CaliforniaUSA
| | - David Elashoff
- Department of Medicine Statistics CoreUniversity of California Los AngelesLos Angeles, CaliforniaUSA
| | - Maie St. John
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California Los AngelesLos Angeles, CaliforniaUSA
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Kim D, Chu S, Khan AU, Compres EV, Zhang H, Gerami P, Wayne JD. Risk factors and patterns of recurrence after sentinel lymph node biopsy for thin melanoma. Arch Dermatol Res 2021; 314:285-292. [PMID: 33884478 DOI: 10.1007/s00403-021-02229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/07/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
While having a thin melanoma (defined as AJCC 8 T1 stage tumor ≤ 1.0 mm) with negative sentinel lymph node biopsy (SLNB) provides an excellent prognosis, some patients still develop recurrence and die. To determine risk factors for any recurrence (local/in-transit, nodal, distant) in thin melanoma patients with negative SLNB and assess survival outcomes. Retrospective review of thin melanomas with negative SLNB from 1999 to 2018 was performed. Two hundred and nine patients were identified. Clinicopathologic characteristics of the primary melanoma were collected. Patterns of recurrence for local/in-transit, nodal or distant recurrence and survival outcomes were analyzed. Eighteen patients (8.6%) developed recurrence: 3 (1.9%) local/in-transit, 4 (2.9%) regional/nodal, and 11 (5.3%) distant recurrence during a median follow-up time of 62 months. A multivariate Cox regression model showed that head and neck site (HR 3.52), ulceration (HR 10.8), and mitotic rate (HR 1.39) were significant risk factors for recurrence. Median time to first recurrence was 49 months. Patients with recurrence had a significantly worse 5 year overall survival than those without recurrence (82.2 vs 99.2%). A retrospective single center study and limited sample size. Did not factor in possible false negative SLNBs when calculating hazard ratios. For thin melanoma patients with negative SLNB, heightened surveillance is warranted for those with ulceration, primary tumor location on the head or neck, and elevated mitotic rate.
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Affiliation(s)
- Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stanley Chu
- Division of Surgical Oncology, Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Arkes 650, Chicago, IL, 60611, USA
| | - Ayesha U Khan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elsy V Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hui Zhang
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey D Wayne
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Division of Surgical Oncology, Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Arkes 650, Chicago, IL, 60611, USA. .,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Pandya R, Basra M, Twohig E, McVeigh K. Can we reduce excision margins for head and neck melanoma? A 12-year retrospective study. Br J Oral Maxillofac Surg 2020; 60:134-139. [PMID: 35123836 DOI: 10.1016/j.bjoms.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022]
Abstract
Although wide local excision is the standard treatment for primary melanoma, the surgical margin remains controversial. Melanomas of the head and neck exhibit higher recurrence rates and worse prognosis than lesions in other body locations, and their close proximity to critical anatomical and functional structures means that wide excision margins are often not feasible. Surgeons must therefore achieve a balance of oncological safety and functional and aesthetic needs. The aim of this study was to retrospectively analyse melanoma data over a 12-year period at a large skin surgery unit to identify potential differences in outcomes in patients who had reduced wide local excision margins for primary head and neck melanoma. The study would provide further evidence for the need for large randomised prospective trials to reduce excision margins for head and neck melanoma. Local cancer network data were retrospectively analysed over a period of 12 years (2008-2019). Data included site, initial stage, multidisciplinary team (MDT) meeting recommendations for excision margins and the actual wide local excision margin taken, recurrence rate, and disease-specific and absolute survival. A total of 222/305 patients (73%) had the recommended excision margin, while in 27% margins were reduced due to anatomical or functional considerations. Recurrence rates were similar (recommended 11.7% vs narrow 13.3% excision margins) (p = 0.64). The mean follow-up time for all patients was 48.5 months. In aesthetically and functionally sensitive areas of the head and neck, wide local excision margins need to be carefully considered after MDT discussion and discussion with the patient. This study suggests the need for further multicentre trials to address the uniqueness of head and neck melanoma.
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Affiliation(s)
- R Pandya
- Worcestershire Royal Hospital, Charles Cavell Way, Worcester, WR5 1DD.
| | - M Basra
- Worcestershire Royal Hospital, Charles Cavell Way, Worcester, WR5 1DD.
| | - E Twohig
- Worcestershire Royal Hospital, Charles Cavell Way, Worcester, WR5 1DD.
| | - K McVeigh
- Worcestershire Royal Hospital, Charles Cavell Way, Worcester, WR5 1DD.
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Goepfert RP, Myers JN, Gershenwald JE. Updates in the evidence-based management of cutaneous melanoma. Head Neck 2020; 42:3396-3404. [PMID: 33463835 DOI: 10.1002/hed.26398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 06/02/2020] [Accepted: 07/14/2020] [Indexed: 11/11/2022] Open
Abstract
Treatment of cutaneous melanoma is changing with significant developments over the past several years that promise to reshape the field of melanoma surgical oncology. Modifications to the staging system based on analysis of a large international dataset, the timing and extent of regional lymphadenectomy, the emergence of effective systemic therapies in the neoadjuvant and adjuvant setting, and the role of adjuvant radiation are all undergoing a data-driven evolution. Surgeon engagement in multidisciplinary decision making remains an essential component of contemporary management for patients across all stages of melanoma and demands specific involvement of head and neck surgical oncologists.
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Affiliation(s)
- Ryan P Goepfert
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, Department of Melanoma Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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8
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Bachar G, Tzelnick S, Amiti N, Gutman H. Patterns of failure in patients with cutaneous head and neck melanoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:914-917. [PMID: 31952929 DOI: 10.1016/j.ejso.2019.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 11/01/2019] [Accepted: 12/20/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The incidence of head and neck melanoma is increasing. Various factors influence prognosis. OBJECTIVE We sought to investigate the subgroup of patients with head and neck melanoma who fail primary treatment and to define the patterns of failure. METHODS The database of a tertiary medical center was reviewed for patients diagnosed and surgically treated for cutaneous head and neck melanoma in 1995-2014. Regional disease failure was defined as disease confirmed in positive SLNB at first assessment or at recurrence. RESULTS The cohort included 141 patients followed for a median duration of 6.8 years (range 1-20 years). Median tumor thickness was 2.1 mm (range 0.5-12 mm). Ulceration was documented in 38 patients (26.9%). Sentinel lymph node biopsy (SLNB) was positive in 18 patients (12.8%). Total disease failure rate was 32.6% with similar rates of regional (n = 26, 18.4%) and distal (n = 22, 15.6%) failure. Most patients (86.3%) with systemic recurrence had a negative SNLB as did 6/26 patients (23%) with regional failure. Forty-three patients (30.4%) died during follow-up, half of them (23 patients, 16.3%) of melanoma. On multivariate analysis, Breslow thickness was the only significant predictor of outcome. CONCLUSIONS The pattern of treatment failure in patients with head and neck melanoma relate predominantly to Breslow thickness. The high false-negative rate of SNLB and the relatively high rate of systemic failures in patients with negative SNLB indicate a low predictive value of this procedure. Efforts to detect systemic disease during follow-up need to be intensified.
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Affiliation(s)
- Gideon Bachar
- Department of Otolaryngology, Head and Neck Surgery, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sharon Tzelnick
- Department of Otolaryngology, Head and Neck Surgery, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nimrod Amiti
- Department of Otolaryngology, Head and Neck Surgery, Beilinson Hospital, Petach Tikva, Israel.
| | - Haim Gutman
- Surgical Oncology Unit, Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
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Knackstedt R, Couto RA, Ko J, Cakmakoglu C, Wu D, Gastman B. Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate. Ann Surg Oncol 2019; 26:3550-3560. [PMID: 31313036 DOI: 10.1245/s10434-019-07617-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature. METHODS Consecutive cutaneous melanoma patients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate. RESULTS Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage. CONCLUSIONS With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.
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Affiliation(s)
- Rebecca Knackstedt
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rafael A Couto
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Cagri Cakmakoglu
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daisy Wu
- University of Toledo Medical School, Toledo, OH, USA
| | - Brian Gastman
- Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
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Namin AW, Cornell GE, Thombs LA, Zitsch RP. Patterns of recurrence and retreatment outcomes among clinical stage I and II head and neck melanoma patients. Head Neck 2019; 41:1304-1311. [PMID: 30629324 DOI: 10.1002/hed.25562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/10/2018] [Accepted: 11/14/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The objective of this study was to determine survival outcomes in patients who underwent retreatment of recurrent cases of cutaneous melanoma of the head and neck (CMHN). METHODS Retrospective review of all patients who were treated for primary clinical stage I or II CMHN between January 1, 2000 and December 31, 2015. RESULTS Twenty percent (33/168) of the patients developed a recurrence. Sixty-six percent (4/6) of patients who developed local recurrence first and 50% (3/6) of patients who developed regional recurrence first were alive without evidence (NED) of disease at last follow-up, while 0% (0/21) of patients who developed distant or simultaneous recurrences first were NED at last follow-up. Among the 7 patients who were NED, the mean time from recurrence to last follow-up was 735 days. CONCLUSIONS Of patients with isolated local or regional recurrences, 58% (7/12) obtained durable curative treatment for recurrent melanoma.
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Affiliation(s)
- Arya W Namin
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri, Columbia, Missouri
| | | | - Lori A Thombs
- Department of Statistics, University of Missouri, Columbia, Missouri
| | - Robert P Zitsch
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri, Columbia, Missouri
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The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous Malignancies. Facial Plast Surg Clin North Am 2019; 27:119-129. [DOI: 10.1016/j.fsc.2018.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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12
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Indocyanine green fluorescence imaging with lymphoscintigraphy for sentinel node biopsy in head and neck melanoma. J Surg Res 2018; 228:77-83. [DOI: 10.1016/j.jss.2018.02.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/11/2017] [Accepted: 02/27/2018] [Indexed: 02/05/2023]
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Risk factors for development of melanoma brain metastasis and disease progression: a single-center retrospective analysis. Melanoma Res 2018; 27:477-484. [PMID: 28800031 DOI: 10.1097/cmr.0000000000000382] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Melanoma metastasis to the brain is associated with a poor prognosis. We sought to determine patient demographics and primary tumor factors associated with the development of brain metastasis (BM) and survival. We also investigated whether the BM detection setting (routine screening vs. symptomatic presentation) affected clinical outcomes. A database of melanoma patients seen from 1999 to 2015 at our institution was reviewed to identify patients who developed BM. Patients with BM were matched by initial stage with patients who did not develop BM as a control group. Patient demographics, primary tumor characteristics, and clinical outcomes were analyzed. A total of 123 patients with BM were matched by initial presenting stage to 237 patients without BM. The characteristics of the primary melanoma tumor associated with BM development included location on the scalp (P=0.030), nodular histologic type (P=0.020), and Breslow depth more than 4 mm (P=0.048), whereas location on the leg was associated with decreased BM risk (P=0.006). In patients with BM, time to first recurrence for melanomas of the scalp was significantly shorter (10.8 vs. 24.8 months, P=0.007) than nonscalp head and neck tumors. Patient stage, tumor depth, nodular type, and ulceration were also associated with worse clinical outcomes. There were no differences in the clinical outcomes between patients whose BM were detected upon routine screening versus those detected upon symptomatic presentation. In summary, factors predictive of development of BM included primary scalp location, nodular type, and depth. In BM patients, scalp location, stage, tumor depth, nodular type, and ulceration, but not detection setting, were associated with worse clinical outcomes.
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Evrard D, Routier E, Mateus C, Tomasic G, Lombroso J, Kolb F, Robert C, Moya-Plana A. Sentinel lymph node biopsy in cutaneous head and neck melanoma. Eur Arch Otorhinolaryngol 2018; 275:1271-1279. [PMID: 29552728 DOI: 10.1007/s00405-018-4934-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Sentinel lymph node biopsy (SLNB) is now a standard of care for cutaneous melanoma, but it is still controversial for cutaneous head and neck melanoma (CHNM). This study aims to confirm the feasibility, accuracy and low morbidity of SLNB in CHNM and evaluate its prognostic value. METHODS A monocentric and retrospective study on patients with CHNM treated in our tertiary care center (Gustave Roussy) between January 2008 and December 2012 was performed. The feasibility, morbidity and prognostic value of this technique were analysed. RESULTS One hundred and twenty-four consecutive patients were included. SLNB was realized in 97.6% of the cases. No significant post-operative morbidity was observed. Nineteen percents of patients had a positive SN while only 14.3% of complete lymph node dissections (CLND) had additional nodal metastasis. The risk of recurrence after positive SN was significantly higher (69.2 vs 30.8%, p = 0.043). The false omission rate was low with 7.1%. Overall survival and disease-free survival were better in the negative SN group (82 vs 49%, p < 0.001 and 69.3 vs 41.8%, p = 0.0131). The risk of recurrence was significantly higher in the positive SN group (p = 0.043) and when primary tumour was ulcerated (p = 0.031). Only the mitotic rate of the primary tumour was associated with SN positivity (p = 0.049). CONCLUSION As in other sites, SLNB status is a strong prognostic factor with comparable false omission rate and no superior morbidity.
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Affiliation(s)
- D Evrard
- Head and Neck Surgery Department, Gustave Roussy Cancer Campus, Paris Sud University, Villejuif, France.
| | - E Routier
- Onco-dermatology Department, Gustave Roussy Cancer Campus, Paris Sud University, Saclay University, Villejuif, France
| | - C Mateus
- Onco-dermatology Department, Gustave Roussy Cancer Campus, Paris Sud University, Saclay University, Villejuif, France
| | - G Tomasic
- Pathology Department, Gustave Roussy Cancer Campus, Paris Sud University, Villejuif, France
| | - J Lombroso
- Nuclear Medicine Department, Gustave Roussy Cancer Campus, Paris Sud University, Villejuif, France
| | - F Kolb
- Plastic and Reconstructive Surgery Department, Gustave Roussy Cancer Campus, Paris Sud University, Villejuif, France
| | - C Robert
- Onco-dermatology Department, Gustave Roussy Cancer Campus, Paris Sud University, Saclay University, Villejuif, France
| | - A Moya-Plana
- Head and Neck Surgery Department, Gustave Roussy Cancer Campus, Paris Sud University, Villejuif, France
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Puza CJ, Josyula S, Terando AM, Howard JH, Agnese DM, Mosca PJ, Lee WT, Beasley GM. Does the number of sentinel lymph nodes removed affect the false negative rate for head and neck melanoma? J Surg Oncol 2018. [PMID: 29513892 DOI: 10.1002/jso.25025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Head and neck (HN) cutaneous melanoma is associated with worse disease-free survival compared to non-HN cutaneous melanoma, possibly due to inadequate staging. We aim to determine if a higher yield of sentinel lymph nodes (SLNs) affected rates of sentinel lymph node biopsy (SLNB) positivity. METHODS Two Cancer Registries were used to identify patients who underwent SLNB for HN melanoma. A false negative (FN) was defined by nodal recurrence after negative SLNB. RESULTS Out of 333 patients who underwent SLNB, 20% (n = 69) had a positive SLN with a FN rate of 6.3%. Those with three or more SLNs had a higher rate of SLN positivity (23.8% [17.5-29.9% CI] vs 16.4% [10.7-23.6% CI]), a lower FN rate (16.7% [10.2-21.2% CI] vs 35.3% [27.1-42.9% CI]), and higher sensitivity (83.3% [82.59-84.09% CI] vs 65.7% [64.87-66.53% CI]) compared to those with one or two SLNs. Of patients in Group 1 (one or two SLNs) with a positive SLN who underwent completion lymph node dissection (20/23), 47% (33-61% CI) had one or more positive non-sentinel nodes compared to 29% (16-51%) of patients in Group 2 (three or more SLNs) (42/46). CONCLUSION In HN melanoma cases in which multiple nodes are identified, removal of all SLNs will more adequately stage patients.
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Affiliation(s)
- Charles J Puza
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Srirama Josyula
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Alicia M Terando
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - John H Howard
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Doreen M Agnese
- Division of Surgical Oncology, Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Paul J Mosca
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Walter T Lee
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Georgia M Beasley
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Zenga J, Nussenbaum B, Cornelius LA, Linette GP, Desai SC. Management Controversies in Head and Neck Melanoma. JAMA FACIAL PLAST SU 2017; 19:53-62. [DOI: 10.1001/jamafacial.2016.1038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Lynn A. Cornelius
- Department of Dermatology, Washington University School of Medicine, St Louis, Missouri
| | - Gerald P. Linette
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Shaun C. Desai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins University School of Medicine, Bethesda, Maryland
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