1
|
Bittar PG, Bittar JM, Etzkorn JR, Brewer JD, Aizman L, Shin TM, Sobanko JF, Higgins HW, Giordano CN, Cohen JV, Pride R, Wan MT, Leitenberger JJ, Bar AA, Aasi S, Bordeaux JS, Miller CJ. Systematic review and meta-analysis of local recurrence rates of head and neck cutaneous melanomas after wide local excision, Mohs micrographic surgery, or staged excision. J Am Acad Dermatol 2021; 85:681-692. [PMID: 33961921 DOI: 10.1016/j.jaad.2021.04.090] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/27/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prospective trials have not compared the local recurrence rates of different excision techniques for cutaneous melanomas on the head and neck. OBJECTIVE To determine local recurrence rates of cutaneous head and neck melanoma after wide local excision (WLE), Mohs micrographic surgery (MMS), or staged excision. METHODS A systematic review of PubMed, EMBASE, and Web of Science identified all English case series, cohort studies, and randomized controlled trials that reported local recurrence rates after surgery for cutaneous head and neck melanoma. A meta-analysis utilizing a random effects model calculated weighted local recurrence rates and confidence intervals (CI) for each surgical technique and for subgroups of MMS and staged excision. RESULTS Among 100 manuscripts with 13,998 head and neck cutaneous melanomas, 51.0% (7138) of melanomas were treated by WLE, 34.5% (4826) by MMS, and 14.5% (2034) by staged excision. Local recurrence rates were lowest for MMS (0.61%; 95% CI, 0.1%-1.4%), followed by staged excision (1.8%; 95% CI, 1.0%-2.9%) and WLE (7.8%; 95% CI, 6.4%-9.3%). LIMITATIONS Definitions of local recurrence varied. Surgical techniques included varying proportions of invasive melanomas. Studies had heterogeneity. CONCLUSION Systematic review and meta-analysis show lower local recurrence rates for cutaneous head and neck melanoma after treatment with MMS or staged excision compared to WLE.
Collapse
Affiliation(s)
- Peter G Bittar
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Julie M Bittar
- Section of Dermatology, Rush University Medical Center, Chicago, Illinois
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Leora Aizman
- George Washington University School of Medicine, Washington, DC
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold W Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justine V Cohen
- Division of Hematology and Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Renee Pride
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Marilyn T Wan
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anna A Bar
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Sumaira Aasi
- Department of Dermatology, Stanford Medicine, Stanford, California
| | | | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
2
|
Prodinger CM, Koller J, Laimer M. Scalp tumors. J Dtsch Dermatol Ges 2018; 16:730-753. [DOI: 10.1111/ddg.13546] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Christine Maria Prodinger
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Josef Koller
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| | - Martin Laimer
- Department of Dermatology; Salzburg Regional Medical Center; Paracelsus Medical University; Salzburg Austria
| |
Collapse
|
3
|
Prodinger CM, Koller J, Laimer M. Tumoren der Kopfhaut. J Dtsch Dermatol Ges 2018; 16:730-754. [DOI: 10.1111/ddg.13546_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Maria Prodinger
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Josef Koller
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| | - Martin Laimer
- Universitätsklinik für Dermatologie; Salzburger Landesklinken - Uniklinikum der Paracelsus Medizinischen Privatuniversität Salzburg; Österreich
| |
Collapse
|
4
|
Freeman SR, Gibbs BB, Brodland DG, Zitelli JA. Prognostic Value of Sentinel Lymph Node Biopsy Compared with that of Breslow Thickness: Implications for Informed Consent in Patients with Invasive Melanoma. Dermatol Surg 2013; 39:1800-12. [DOI: 10.1111/dsu.12351] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
5
|
Tcheung WJ, Nelson K, Aldabagh B, Puja P. Pathologic features of pediatric head and neck melanoma. Pediatr Dermatol 2013; 30:568-73. [PMID: 23627731 DOI: 10.1111/pde.12153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Although malignant melanoma is rare in children, its incidence is steadily increasing, and it is potentially lethal. Few studies have examined head and neck melanoma in children, and even fewer have focused on the histopathologic features of melanoma within this anatomic region. To further the understanding of this entity, we examined pathology specimens from nine subjects age 18 years and younger with an original diagnosis of head or neck melanoma. The anatomic locations of these primary melanomas were the face and nose (n = 4), scalp and neck (n = 4), and ear (n = 1). The cases included seven superficial spreading melanomas, one unclassified (possible nodular) melanoma, and one melanoma in situ. No melanomas demonstrating desmoplastic or spindle cell morphologies were noted upon review. Breslow depth ranged from 0 to 2.9 mm (mean 1.3 mm, median 0.6 mm), with Clark level ranging from I to V. Pagetoid scatter was found in eight cases. Other notable features included regression (n = 5), ulceration (n = 1), and associated melanocytic nevus (n = 4). We did not observe any small cell variants; all nine cases had an epithelioid appearance. Nor was any melanoma-associated mortality observed at last follow-up (mean 60.4 mos, median 48 mos, range 2-174 mos). These histopathologic features were consistent with adult-type melanoma, which is in agreement with other histopathologic studies of melanoma in children.
Collapse
Affiliation(s)
- Win Janet Tcheung
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | | | | | | |
Collapse
|
6
|
Pannucci CJ, Collar RM, Johnson TM, Bradford CR, Rees RS. The role of full-thickness scalp resection for management of primary scalp melanoma. Ann Plast Surg 2012; 69:165-8. [PMID: 21734540 DOI: 10.1097/sap.0b013e31822592e7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Scalp melanoma is aggressive and has a proclivity for regional metastasis. We hypothesize that subperiosteal scalp melanoma resection reduces in-transit/satellite recurrence, when compared with subgaleal resection. METHODS We identified patients with intermediate to deep, primary scalp melanoma referred to head/neck surgery over an 8-year period. Patients were compared based on scalp resection depth, including subperiosteal (resection to the level of calvarium) and subgaleal (resection including skin, subcutaneous tissue, and galea). The dependent variables were in-transit/satellite recurrence and time to in-transit/satellite recurrence. RESULTS Among 48 identified patients, the in-transit/satellite recurrence rate was 16.7%. Subgaleal resection patients had higher in-transit/satellite recurrence rates than subperiosteal resection patients (24.0% vs. 8.7%, P=0.155). Among node-negative patients, subgaleal resection had significantly higher in-transit/satellite metastasis rates when compared with subperiosteal resection (26.3% vs. 0%, P=0.047). CONCLUSION For node-negative, primary scalp melanoma, subperiosteal resection significantly decreases in-transit/satellite recurrence when compared with subgaleal resection. Given our small sample size, further studies are necessary to confirm these results.
Collapse
Affiliation(s)
- Christopher J Pannucci
- Section of Plastic Surgery, Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan 48105, USA
| | | | | | | | | |
Collapse
|
7
|
de Rosa N, Lyman GH, Silbermins D, Valsecchi ME, Pruitt SK, Tyler DM, Lee WT. Sentinel Node Biopsy for Head and Neck Melanoma. Otolaryngol Head Neck Surg 2011; 145:375-82. [DOI: 10.1177/0194599811408554] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. This systematic review was conducted to examine the test performance of sentinel node biopsy in head and neck melanoma, including the identification rate and false-negative rate. Data Sources. PubMed, EMBASE, ASCO, and SSO database searches were conducted to identify studies fulfilling the following inclusion criteria: sentinel node biopsy was performed, lesions were located on the head and neck, and recurrence data for both metastatic and nonmetastatic patients were reported. Review Methods. Dual-blind data extraction was conducted. Primary outcomes included identification rate and test performance based on completion neck dissection or nodal recurrence. Results. A total of 3442 patients from 32 studies published between 1990 and 2009 were reviewed. Seventy-eight percent of studies were retrospective and 22% were prospective. Trials varied from 9 to 755 patients (median 55). Mean Breslow depth was 2.53 mm. Median sentinel node biopsy identification rate was 95.2%. More than 1 basin was reported in 33.1% of patients. A median of 2.56 sentinel nodes per patient were excised. Sentinel node biopsy was positive in 15% of patients. Subsequent completion neck dissection was performed in almost all of these patients and revealed additional positive nodes in 13.67%. Median follow-up was 31 months. Across all studies, predictive value positive for nodal recurrence was 13.1% and posttest probability negative was 5%. Median false-negative rate for nodal recurrence was 20.4%. Conclusion. Sentinel node biopsy of head and neck melanoma is associated with an increased false-negative rate compared with studies of non–head and neck lesions. Positive sentinel node status is highly predictive of recurrence.
Collapse
Affiliation(s)
| | - Gary H. Lyman
- Duke University, Durham, North Carolina, USA
- Duke Comprehensive Cancer Center, Durham, North Carolina, USA
| | | | | | - Scott K. Pruitt
- Duke University, Durham, North Carolina, USA
- VA Medical Center, Durham, North Carolina, USA
| | - Douglas M. Tyler
- Duke University, Durham, North Carolina, USA
- VA Medical Center, Durham, North Carolina, USA
| | - Walter T. Lee
- Duke University, Durham, North Carolina, USA
- VA Medical Center, Durham, North Carolina, USA
| |
Collapse
|
8
|
Torres F, Fabbrocini G, Hirata SH, Yamada S, De Vita V, Annunziata MC, Tosti A. Dermoscopy of scalp melanoma: report of three cases. Cancers (Basel) 2010; 2:1597-601. [PMID: 24281175 PMCID: PMC3837324 DOI: 10.3390/cancers2031597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 07/27/2010] [Accepted: 08/16/2010] [Indexed: 11/22/2022] Open
Abstract
Scalp melanoma is rare and often late-discovered because of its unusual position. As a consequence, its prognosis is poorer than melanoma on other body sites and only few clinical reports about its dermoscopic pattern have been published. In this paper, we report three clinical cases of scalp melanoma with photographic documentation and dermoscopic images, in order to improve the early detection of scalp melanoma.
Collapse
Affiliation(s)
- Fernanda Torres
- Institute of Dermatology of Rio de Janeiro (IDERJ), Rio de Janeiro, Brazil; E-Mail:
| | - Gabriella Fabbrocini
- Department of Systematic Pathology, Division of Dermatology, University of Naples Federico II, Naples, Italy; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel: +39-081-746-4386; Fax: +39-081-746-2442
| | - Sergio Henrique Hirata
- Department of Dermatology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; E-Mails: (S.Y.); (S.H.H.)
| | - Sergio Yamada
- Department of Dermatology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil; E-Mails: (S.Y.); (S.H.H.)
| | - Valerio De Vita
- Department of Systematic Pathology, Division of Dermatology, University of Naples Federico II, Naples, Italy; E-Mail:
| | - Maria Carmela Annunziata
- Department of Systematic Pathology, Division of Dermatology, University of Naples Federico II, Naples, Italy; E-Mail:
| | - Antonella Tosti
- Department of Internal Medicine, Geriatrics and Nephrology, Division of Dermatology, University of Bologna, Bologna, Italy; E-Mail:
| |
Collapse
|
9
|
Rigual NR, Popat SR, Jayaprakash V, Jaggernauth W, Wong M. Cutaneous head and neck melanoma: the old and the new. Expert Rev Anticancer Ther 2008; 8:403-12. [PMID: 18366288 DOI: 10.1586/14737140.8.3.403] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The incidence rate of malignant melanoma has shown a rapid worldwide rise in recent years. The staging and management of head and neck melanoma presents some unique challenges. Surgery remains the cornerstone of treatment, while sentinel node biopsy is the most accurate staging modality for regional disease. The complex regional anatomy and lymphovascular drainage of this region may account for the increased biologic aggressiveness and treatment challenges of this disease. Improved understanding of the radiobiology of melanoma has resulted in new adjuvant radiotherapy approaches, yielding improved control rates. The treatment outcomes of metastatic head and neck melanoma remain disappointing but important progress has been made in the understanding of melanoma biology.
Collapse
Affiliation(s)
- Nestor R Rigual
- Roswell Park Cancer Institute, Department of Head & Neck Surgery & Plastic Surgery, Buffalo, NY-14263, USA.
| | | | | | | | | |
Collapse
|