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Rozendorn N, Shutan I, Feinmesser G, Grynberg S, Hodadov H, Alon E, Asher N. Real-World Outcomes of Inoperable and Metastatic Cutaneous Head and Neck Melanoma Patients. Laryngoscope 2024; 134:2762-2770. [PMID: 38230960 DOI: 10.1002/lary.31290] [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: 09/02/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVE This study aims to describe the overall survival (OS) and to identify associated prognostic factors in patients with inoperable and metastatic cutaneous melanoma of the head and neck (H&N) region, undergoing modern systemic treatments. METHODS This is a retrospective single institutional study. Data on all consecutive H&N melanoma patients treated with systemic oncologic treatments between 2015 and 2022 were collected from electronic medical files. Kaplan-Meier curves were used to describe survival and Cox regression analysis was used to identify patient and tumor factors associated with prognosis. RESULTS A total of 144 patients were included. Median OS was 45 months (95% confidence interval [CI] 28-65 m). On univariable analysis for OS, the primary disease site, specifically the nape and neck (hazard ratio [HR] 3.3, 95% CI 1.4-7.7, p = 0.007), high Eastern Cooperative Oncology Group Performance Status ([ECOG-PS], HR 2.5, 95% CI = 1.9-3.3, p < 0.001), high lactate dehydrogenase (LDH) levels (HR 2.8, 95% CI = 1.7-4.6, p < 0.001), and treatment with targeted therapy (TT) as compared with immunotherapy (HR 2.6, 95% CI = 1.06-6.3, p = 0.03) were all associated with shorter OS. High-grade adverse events (AEs) were associated with a longer OS (HR 0.41, 95% CI = 0.25-0.68, p = 0.001). On multivariable analysis for OS, the ECOG-PS, LDH levels, site of disease, and the development of moderate-severe AEs remained significant. CONCLUSIONS In the era of modern oncologic treatments, the prognosis of inoperable and metastatic cutaneous H&N melanoma aligns with other cutaneous melanomas. Primary tumor site of the nape and neck region emerges as a significant prognostic factor. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2762-2770, 2024.
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Affiliation(s)
- Noa Rozendorn
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medica Center, Ramat Gan, Israel
| | - Itay Shutan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Feinmesser
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medica Center, Ramat Gan, Israel
| | - Shirly Grynberg
- Ella Lemelbaum Institute of Immuno-Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Hadas Hodadov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Alon
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medica Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nethanel Asher
- Skin Cancer and Melanoma Center, Davidoff Center, Beilinson Medical Center, Petah Tikva, Israel
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Dwivedi N, Barsoum R, Moore J, Rathbone E. Survival outcomes of head and neck melanoma patients in Queensland, Australia from 2009 to 2018. Australas J Dermatol 2023; 64:488-496. [PMID: 37606304 DOI: 10.1111/ajd.14140] [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: 10/14/2022] [Revised: 07/05/2023] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND/OBJECTIVES To compare survival outcomes for patients with cutaneous invasive head and neck melanoma (HNM) with those of patients with melanoma on other anatomical sites. METHODS Retrospective cohort study using patient data extracted from the Cancer Alliance Queensland's Oncology Analysis System (OASYS) over a 10-year period from 2009 to 2018. Melanoma-specific survival was compared between patients with HNM and non-HNM. Kaplan-Meier survival estimates were calculated at 5 and 10 years. Univariable and multivariable Cox proportional hazards regression analysis determined factors associated with survival. RESULTS The 5- and 10-year survival probabilities were 90.7% and 89.1%, respectively for HNM, compared with 94.7% and 93.0%, respectively, for non-HNM melanoma. The 5- and 10-year survival probabilities for scalp melanoma were 77.8% and 75.5%, respectively. Patients with HNM died of melanoma at 1.22 times (HR 1.22, 95% CI 1.09-1.37) the rate of those with non-HNM, controlling for sex, age, socioeconomic status, remoteness, Breslow thickness, the presence of multiple invasion melanoma and ulceration. Patients with scalp melanoma died of melanoma at 1.57 times (HR 1.57, 95% CI 1.26-1.95) the rate of those with non-scalp HNM. CONCLUSIONS There is a statistically significant survival difference between patients with HNM and non-HNM, and between patients with scalp melanoma and non-scalp HNM, even after adjusting for prognostic factors.
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Affiliation(s)
- Nikhil Dwivedi
- Princess Alexandra Hospital - Metro South HHS, Woolloongabba, Queensland, Australia
| | - Ramez Barsoum
- Dermatology Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Julie Moore
- Princess Alexandra Hospital - Metro South HHS, Woolloongabba, Queensland, Australia
| | - Evelyne Rathbone
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
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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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Gulliver W, Gulliver S, Power RJ, Penney M, Lane D. The Incidence of Cutaneous Malignant Melanoma in Eastern Newfoundland and Labrador, Canada, from 2007 to 2015. Dermatology 2021; 238:527-533. [PMID: 34610598 DOI: 10.1159/000519193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of cutaneous malignant melanoma continues to increase worldwide and in Canada. It is unclear whether the increase in incidence and clinical characteristic trends of cutaneous malignant melanoma are similar in the province of Newfoundland and Labrador. OBJECTIVE The objective of this study is to examine the incidence and trends of cutaneous malignant melanoma in Eastern Newfoundland and Labrador. METHODS Patients aged 18 years or older diagnosed with cutaneous malignant melanoma were identified from the Eastern Health Authority's Cancer Registry. The diagnosis was confirmed by a pathologist via histological subtype. Patients were excluded if the diagnosis was unspecified, a nonmelanoma skin cancer or if there was a recurrence in the same lesion location. In total 298 patients diagnosed with cutaneous malignant melanoma from 2007 to 2015 were included in the analysis. RESULTS The total incidence increased from 4.1 to 15.6 cases/100,000 person-years, which represents a 283.0% increase from 2007 to 2015. The largest increases in incidence were seen in males and patients aged from 60 to 79 years. The most common lesion anatomical locations were the trunk in males and the lower extremity in females. The majority of cases had a Breslow thickness below 1.0 mm. CONCLUSION The incidence of cutaneous malignant melanoma in Eastern Newfoundland and Labrador is increasing at a faster rate than in any other region in Canada. Health care providers should work to be aware of the clinical trends and risk factors associated with this disease to facilitate early detection and prevent morbidity.
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Affiliation(s)
- Wayne Gulliver
- Department of Dermatology, Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
- Newlab Clinical Research Inc., St. John's, Newfoundland, Canada
| | | | - Rebecca J Power
- Newlab Clinical Research Inc., St. John's, Newfoundland, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Michelle Penney
- Newlab Clinical Research Inc., St. John's, Newfoundland, Canada
| | - David Lane
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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Ding Y, Jiang R, Chen Y, Jing J, Yang X, Wu X, Zhang X, Xu J, Xu P, LiuHuang SC, Lu Z. Comparing the characteristics and predicting the survival of patients with head and neck melanoma versus body melanoma: a population-based study. BMC Cancer 2021; 21:420. [PMID: 33863315 PMCID: PMC8052690 DOI: 10.1186/s12885-021-08105-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Previous studies reported cutaneous melanoma in head and neck (HNM) differed from those in other regions (body melanoma, BM). Individualized tools to predict the survival of patients with HNM or BM remain insufficient. We aimed at comparing the characteristics of HNM and BM, developing and validating nomograms for predicting the survival of patients with HNM or BM. METHODS The information of patients with HNM or BM from 2004 to 2015 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The HNM group and BM group were randomly divided into training and validation cohorts. We used the Kaplan-Meier method and multivariate Cox models to identify independent prognostic factors. Nomograms were developed via the rms and dynnom packages, and were measured by the concordance index (C-index), the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and calibration plots. RESULTS Of 70,605 patients acquired, 21% had HNM and 79% had BM. The HNM group contained more older patients, male sex and lentigo maligna melanoma, and more frequently had thicker tumors and metastases than the BM group. The 5-year cancer-specific survival (CSS) and overall survival (OS) rates were 88.1 ± 0.3% and 74.4 ± 0.4% in the HNM group and 92.5 ± 0.1% and 85.8 ± 0.2% in the BM group, respectively. Eight variables (age, sex, histology, thickness, ulceration, stage, metastases, and surgery) were identified to construct nomograms of CSS and OS for patients with HNM or BM. Additionally, four dynamic nomograms were available on web. The internal and external validation of each nomogram showed high C-index values (0.785-0.896) and AUC values (0.81-0.925), and the calibration plots showed great consistency. CONCLUSIONS The characteristics of HNM and BM are heterogeneous. We constructed and validated four nomograms for predicting the 3-, 5- and 10-year CSS and OS probabilities of patients with HNM or BM. These nomograms can serve as practical clinical tools for survival prediction and individual health management.
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Affiliation(s)
- Yuxin Ding
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Runyi Jiang
- Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Yuhong Chen
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Jing Jing
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Xiaoshuang Yang
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Xianjie Wu
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Xiaoyang Zhang
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Jiali Xu
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China
| | - Piaopiao Xu
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China
| | | | - Zhongfa Lu
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, No. 88, Jiefang Road, Hangzhou, 310009, China.
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6
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Huang K, Misra S, Lemini R, Chen Y, Speicher LL, Dawson NL, Tolaymat LM, Bagaria SP, Gabriel EM. Completion lymph node dissection in patients with sentinel lymph node positive cutaneous head and neck melanoma. J Surg Oncol 2020; 122:1057-1065. [PMID: 32654173 DOI: 10.1002/jso.26119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/13/2020] [Accepted: 06/18/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Relatively few cutaneous head and neck melanoma (CHNM) patients with were included in the multicenter selective lymphadenectomy trial II (MSLT-II). Our objective was to investigate whether immediate completion lymph node dissection completion of lymph node dissection (CLND) was associated with survival benefit for sentinel lymph node (SLN) positive CHNM using the National Cancer Database. METHODS SLN positive patients with CHNM from 2012 to 2014 were retrospectively analyzed. Patients were divided into two groups: those who underwent SLN biopsy (SLNB) only versus those who underwent SLNB followed by CLND (SLNB + CLND). The primary outcome was 5-year overall survival (OS). RESULTS Among 530 SLNB + patients, 342 patients underwent SLNB followed by CLND (SLNB + CLND). The SLNB only group had fewer positive SLN, less advanced pathologic stage, and a lower rate of adjuvant immunotherapy. There was no significant difference in 5-year OS between the two groups (51.0% vs 67%; P = .56). After adjusting for pathologic stage, there remained no difference in 5-year OS among patients with stage IIIA (63.0% vs. 73.6%, P = 0.22) or IIIB/IIIC disease (39.1% vs 57.8%; P = .52). Conclusions Using a large nationwide database, CLND was not shown to be associated with improved OS for patients with SLNB positive CHNM, validating the results of MSLT-II.
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Affiliation(s)
- Kai Huang
- Department of General Surgery, Brandon Regional Hospital, HCA healthcare/USF Morsani College of Medicine GME, Brandon, Florida
| | - Subhasis Misra
- Department of General Surgery, Brandon Regional Hospital, HCA healthcare/USF Morsani College of Medicine GME, Brandon, Florida
| | - Riccardo Lemini
- Department of Surgical Oncology, Mayo Clinic, Jacksonville, Florida
| | - Yong Chen
- Department of Musculoskeletal Surgery, Shanghai Medical College, Fudan University Shanghai Cancer, Shanghai, China
| | | | - Nancy L Dawson
- Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Sanjay P Bagaria
- Department of Surgical Oncology, Mayo Clinic, Jacksonville, Florida
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Black NR, O'Reilly GA, Pun S, Black DS, Woodley DT. Improving Hairdressers' Knowledge and Self-efficacy to Detect Scalp and Neck Melanoma by Use of an Educational Video. JAMA Dermatol 2019; 154:214-216. [PMID: 29214298 DOI: 10.1001/jamadermatol.2017.4267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Neda R Black
- University of Colorado Anschutz Medical Campus, Aurora
| | | | - Stacey Pun
- Keck School of Medicine, University of Southern California, Los Angeles
| | - David S Black
- Keck School of Medicine, University of Southern California, Los Angeles
| | - David T Woodley
- Keck School of Medicine, University of Southern California, Los Angeles
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8
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Abstract
BACKGROUND Most head and neck melanomas occur on the face, with the cheek being the most frequently affected site. So far, small numbers of researches on cheek melanomas have yielded insufficient and controversial results. In this trial, we aimed to define the histopathological and clinical features specific to cheek melanomas and to compare them with other head and neck melanomas by using a large group of patients from a single tertiary center. PATIENTS AND METHODS A total of 98 cheek melanomas and 183 other (noncheek) head and neck melanoma cases were analyzed retrospectively. RESULTS The median age was 62 years and malar/zygomatic was the mostly affected site (78.6%). The cheek melanomas developed more frequently in females (61.2%) and most of them were associated with lentigo maligna histopathological subtype (49.2%) and early-stage disease (stage 0-II) (77.6%). The cheek melanomas were found more significantly associated with older patients (P = 0.05), females (P = 0.0001), lentigo maligna subtype (P = 0.0001), lower vertical growth phase (P = 0.03), and early-stage of disease (P = 0.0001) compared with other lesions that developed other sites. Furthermore, they were associated with lower relapse rates (18.6% vs 39.5%, P = 0.0001) and the 5-year recurrence-free survival rate of cheek melanomas was 80% (P = 0.002). Moreover, the 5-year overall survival rate of cheek melanomas was 62%, and they were found to be associated with a favorable overall survival (P = 0.004). CONCLUSIONS Cheek melanomas are associated with lower relapse rates and favorable outcomes compared with other (noncheek) head and neck melanomas.
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Affiliation(s)
- Faruk Tas
- From the Department of Medical Oncology, Institute of Oncology, University of Istanbul, Istanbul, Turkey
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Paolino G, Cardone M, Didona D, Moliterni E, Losco L, Corsetti P, Schipani G, Lopez T, Calvieri S, Bottoni U. Prognostic factors in head and neck melanoma according to facial aesthetic units. GIORN ITAL DERMAT V 2017; 155:41-45. [PMID: 28748684 DOI: 10.23736/s0392-0488.17.05685-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Head and neck melanoma is a clinical challenge. Indeed, cutaneous head and neck melanoma shows a worse prognosis in comparison to melanomas of other body sites. Although the emphasis on facial cosmetic preservation plays a pivotal role in comparison to other body areas, specific Facial Aesthetic Units (FAU) could also play a key role in the prognostic evaluation of the malignancy. METHODS The aim of the current study was to evaluate the general outcome and clinicopathological features of head and neck melanoma and to detect prognostic differences according to each FAU. The Kaplan-Meier product was used to calculate survival curves, while Cox proportional-hazard regression was performed to evaluate the predictive value of each FAU. RESULTS A total of 221 head and neck melanoma patients was included in our analysis. In the nasal FAU, we found a high rate of local recurrence, which affected significantly disease-free survival. The worse prognosis was observed in melanoma of the scalp, which showed a greater tendency to skip metastases in internal organs. Moreover, we found that scalp showed a low incidence of non-melanoma skin cancers, if compared to other FAU, highlighting that the scalp local milieu might play a more prominent role in melanoma biology than chronic UV exposition. CONCLUSIONS Although FAUs have an aesthetic function, they could also play a role in the evaluation and follow-up of melanoma.
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Affiliation(s)
| | | | - Dario Didona
- First Division of Dermatology, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy -
| | | | - Luigi Losco
- Department of Plastic, Reconstructive and Aesthetic Surgery, Sapienza University, Rome, Italy
| | | | - Giusy Schipani
- Department of Dermatology, Magna Graecia University, Catanzaro, Italy
| | - Teresa Lopez
- Dermatological Clinic, Sapienza University, Rome, Italy
| | | | - Ugo Bottoni
- Department of Dermatology, Magna Graecia University, Catanzaro, Italy
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Kadakia S, Chan D, Mourad M, Ducic Y. The Prognostic Value of Age, Sex, and Subsite in Cutaneous Head and Neck Melanoma: A Clinical Review of Recent Literature. IRANIAN JOURNAL OF CANCER PREVENTION 2016; 9:e5079. [PMID: 27703647 PMCID: PMC5038835 DOI: 10.17795/ijcp-5079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/21/2016] [Accepted: 06/05/2016] [Indexed: 12/29/2022]
Abstract
Context Cutaneous head and neck melanoma is a challenging disease owing to its aggressive nature and often times advanced stage at presentation. Age, sex, and subsite are three prognostic indicators which can be determined prior to treatment or testing, and can allow the practitioner to counsel the patient before initiating therapy. Evidence Acquisition A PubMed search was conducted utilizing various terms relating to the subject matter. Articles over the past 25 years were analyzed and appropriately selected for review. Results It appears that patients older than 65 have a decreased overall 5 year survival compared to their younger counterparts. Male patients have poorer prognosis compared to female patients as noted by the decreased overall survival, decreased disease specific survival, and shorter time to distant metastasis. Scalp subsite was most uniformly accepted as having the worst prognosis in the head and neck, and may even serve as an independent prognostic indicator. Conclusions Advanced age, male sex, and scalp subsite all portend poor prognosis in patients with cutaneous head and neck melanoma.
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Affiliation(s)
- Sameep Kadakia
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - David Chan
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery Associates, Dallas-Fort Worth, Texas
| | - Moustafa Mourad
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - Yadranko Ducic
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery Associates, Dallas-Fort Worth, Texas
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Andtbacka RHI, Agarwala SS, Ollila DW, Hallmeyer S, Milhem M, Amatruda T, Nemunaitis JJ, Harrington KJ, Chen L, Shilkrut M, Ross M, Kaufman HL. Cutaneous head and neck melanoma in OPTiM, a randomized phase 3 trial of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor for the treatment of unresected stage IIIB/IIIC/IV melanoma. Head Neck 2016; 38:1752-1758. [PMID: 27407058 PMCID: PMC5129499 DOI: 10.1002/hed.24522] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/14/2016] [Accepted: 05/16/2016] [Indexed: 12/19/2022] Open
Abstract
Background Cutaneous head and neck melanoma has poor outcomes and limited treatment options. In OPTiM, a phase 3 study in patients with unresectable stage IIIB/IIIC/IV melanoma, intralesional administration of the oncolytic virus talimogene laherparepvec improved durable response rate (DRR; continuous response ≥6 months) compared with subcutaneous granulocyte‐macrophage colony‐stimulating factor (GM‐CSF). Methods Retrospective review of OPTiM identified patients with cutaneous head and neck melanoma given talimogene laherparepvec (n = 61) or GM‐CSF (n = 26). Outcomes were compared between talimogene laherparepvec and GM‐CSF treated patients with cutaneous head and neck melanoma. Results DRR was higher for talimogene laherparepvec–treated patients than for GM‐CSF treated patients (36.1% vs 3.8%; p = .001). A total of 29.5% of patients had a complete response with talimogene laherparepvec versus 0% with GM‐CSF. Among talimogene laherparepvec–treated patients with a response, the probability of still being in response after 12 months was 73%. Median overall survival (OS) was 25.2 months for GM‐CSF and had not been reached with talimogene laherparepvec. Conclusion Treatment with talimogene laherparepvec was associated with improved response and survival compared with GM‐CSF in patients with cutaneous head and neck melanoma. © 2016 Wiley Periodicals, Inc. Head Neck38: 1752–1758, 2016
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Affiliation(s)
| | - Sanjiv S Agarwala
- St. Luke's University Hospital and Temple University, Philadelphia, Pennsylvania
| | - David W Ollila
- University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | | | | | - Lisa Chen
- Amgen, Inc, Thousand Oaks, California
| | | | - Merrick Ross
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Pasquali S, Montesco MC, Ginanneschi C, Baroni G, Miracco C, Urso C, Mele F, Lombardi AR, Quaglino P, Cattaneo L, Staibano S, Botti G, Visca P, Zannoni M, Soda G, Corti B, Pilloni L, Anselmi L, Lissia A, Vannucchi M, Manieli C, Massi D. Lymphatic and blood vasculature in primary cutaneous melanomas of the scalp and neck. Head Neck 2015; 37:1596-602. [PMID: 24931916 DOI: 10.1002/hed.23801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/12/2014] [Accepted: 06/11/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Scalp/neck melanomas have a poor prognosis, possibly because of a rich vascular supply that prompts tumor cells' dissemination. METHODS We compared the accuracy of immunohistochemical (IHC) staining with morphology for the identification of lymphovascular invasion in 156 scalp/neck melanomas. We then analyzed the association of vessel invasion and density with pathological features and survival. RESULTS IHC-detected lymphatic vessel invasion (LVI) and blood vessel invasion (BVI) were identified in 34.6% and 13.5% of cases, respectively. IHC increased the LVI/BVI detection compared to morphology (40.4% vs 16.6%; p < .001). The degree of peritumoral and intratumoral blood vessel density (BVD) was greater than lymphatic vessel density (LVD). Ulceration was the only factor independently associated with intratumoral (p = .029) and peritumoral (p = .047) BVD. Tumor thickness was the only independent predictor of survival (p = .002). CONCLUSION IHC allows accurate assessment of lymphovascular invasion in scalp/neck melanomas. In these tumors, we observed a high incidence of BVI, which deserves further investigations.
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Affiliation(s)
- Sandro Pasquali
- Melanoma and Sarcomas Unit, Veneto Institute of Oncology, Padova, Italy
| | | | | | | | | | | | - Fabio Mele
- "Di Venere" and "San Paolo" Hospital, Bari, Italy
| | | | | | | | | | | | - Paolo Visca
- National Cancer Institute "Regina Elena,", Roma, Italy
| | - Marina Zannoni
- Azienda Ospedaliero Universitaria Integrata Verona, Verona, Italy
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Rawlani R, Rawlani V, Qureshi HA, Kim JY, Wayne JD. Reducing margins of wide local excision in head and neck melanoma for function and cosmesis: 5-year local recurrence-free survival. J Surg Oncol 2015; 111:795-9. [PMID: 25712156 DOI: 10.1002/jso.23886] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/28/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND The proximity of head and neck (H&N) melanomas to critical anatomical structures requires that surgeons achieve a balance between adequate margins of excision and the functional and cosmetic needs of patients. This study sought to determine the risk associated with reducing margins of wide local excision (WLE) in H&N melanoma and to identify risk factors of recurrence. METHODS Seventy-nine cases of primary, invasive H&N melanoma were treated by WLE and followed prospectively for local recurrence. Forty-two WLEs were performed according to current practice guidelines (1cm for lesions<1.0 mm thick, 1-2 cm for lesions 1.01-2.0 mm thick, and 2 cm for lesions >2.0 mm thick). Reduced margins (0.5 cm for lesions ≤1.0 mm thick, 0.5-1.0 cm for lesions 1.01-2.0 mm thick, and 1.0 cm for lesion >2.0 mm thick) were utilized in 37 cases to preserve critical anatomical structures such as the eyelid, nose, mouth and auricle. RESULTS Overall local recurrence rate was 8.9% over a mean follow-up period of 71.3 months and a minimum of 60 months. Reducing margins of WLE did not increase local recurrence rates as demonstrated by local recurrence-free survival (90.4% vs. 91.9%, P = 0.806). CONCLUSION Margins of WLE may be safely reduced in melanomas in close proximity to structures of the H&N without affecting local recurrence rates.
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Affiliation(s)
- Roshni Rawlani
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinios
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14
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Supriya M, Narasimhan V, Henderson MA, Sizeland A. Managing regional metastasis in patients with cutaneous head and neck melanoma - is selective neck dissection appropriate? Am J Otolaryngol 2014; 35:610-6. [PMID: 25080830 DOI: 10.1016/j.amjoto.2014.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 06/21/2014] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neck dissection is recommended for patients with head and neck cutaneous melanoma and nodal metastasis. However, there appears to be no clear evidence to guide the extent of nodal resection. METHODS Loco-regional recurrence (LR), overall survival (OS) and progression free survival (PFS) was retrospectively compared between patients who had Comprehensive neck dissection (CND) and Selective neck dissection (SND). RESULTS There was no difference in LR, OS and PFS between CND (n=18) and SND groups (n=79). Extra capsular extension (ECE), frontal disease and increasing number of involved nodes resulted in worse OS and PFS but had no impact on LR. CONCLUSION Patients with disease limited to one node without ECE can be effectively treated by SND alone. In patients who have these unfavourable pathological features more extensive nodal resection does not improve outcome if they receive radiotherapy. Extent of neck dissection or adjuvant radiotherapy has no impact on overall survival.
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Affiliation(s)
| | | | - Michael A Henderson
- Division of Cancer Surgery, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Andrew Sizeland
- Division of Head and Neck Surgery, Peter MacCallum Cancer Center, Melbourne, Australia
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Millare GG, Guha-Thakurta N, Sturgis EM, El-Naggar AK, Debnam JM. Imaging findings of head and neck dermatofibrosarcoma protuberans. AJNR Am J Neuroradiol 2014; 35:373-8. [PMID: 23907249 DOI: 10.3174/ajnr.a3650] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Dermatofibrosarcoma protuberans is a rare, locally aggressive sarcoma of the skin in children and adults, usually involving the trunk and extremities and less commonly the head and neck. Despite clinical reports in the literature on the management of dermatofibrosarcoma protuberans, there are limited articles describing its imaging features. MATERIALS AND METHODS We retrospectively reviewed the demographics and imaging findings in all 24 patients with pathologically proven dermatofibrosarcoma protuberans of the head and neck seen at a tertiary cancer center between 2001 and 2010. RESULTS Twenty-two of the 24 lesions were nodular and well circumscribed; 19 of the 24 were located on the scalp. On imaging, all 24 lesions involved subcutaneous tissues. The lesions ranged in size from 0.6-9.5 cm (mean, 3.7 cm; standard deviation, 2.3 cm). Twelve lesions involved the soft tissues either at or extending directly to the midline. Thirteen lesions were associated with bulging of the skin surface. Fourteen lesions were imaged with CT and 14 with MR imaging. Whereas variable enhancement patterns were noted on CT and MR imaging, dermatofibrosarcoma protuberans was usually T2-hyperintense and demonstrated marked enhancement. None of the lesions was associated with bone invasion, perineural spread, or nodal/distant metastasis. CONCLUSIONS Knowledge of the imaging characteristics of dermatofibrosarcoma protuberans may alert neuroradiologists to include dermatofibrosarcoma protuberans in the differential diagnosis of lesions about the head and neck with similar imaging characteristics.
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Affiliation(s)
- G G Millare
- From the Department of Diagnostic Radiology (G.G.M.), Baylor College of Medicine, Houston, Texas
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16
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Arce PM, Camilon PR, Stokes WA, Nguyen SA, Lentsch EJ. Is sex an independent prognostic factor in cutaneous head and neck melanoma? Laryngoscope 2013; 124:1363-7. [PMID: 24122966 DOI: 10.1002/lary.24439] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 09/11/2013] [Accepted: 09/16/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if sex independently affects disease-specific survival (DSS) in patients with cutaneous head and neck melanoma. STUDY DESIGN Retrospective analysis of a large population database. METHODS Our study included patients in the Surveillance, Epidemiology, and End Results database with cutaneous head and neck melanoma diagnosed from 2004 to 2009. Any cases with a history of previous malignancy or with multiple primaries were excluded. We obtained data on stage, race, age at diagnosis, radiological treatment status, and surgical treatment status. Our analysis consisted of a Kaplan-Meier analysis of DSS by sex [correction made here after initial online publication] that was supported by a multivariate Cox regression of all significant variables studied. RESULTS There were 13,507 patients identified with cutaneous head and neck melanoma who were diagnosed between 2004 and 2009. We observed that female patients had a better prognosis than their male counterparts, with 5-year DSS of 90.40% (95% confidence interval [CI], 89.03%-91.72%) and 87.10% (95% CI, 86.12%-88.08%), respectively. Multivariable analysis demonstrated a statistically significant decrease in disease-specific hazard ratio due to female sex independent of stage, treatment, age, or race. CONCLUSIONS Our study concludes that female sex is an independent prognostic factor for cutaneous head and neck melanoma. We demonstrated better 5-year DSS in female compared to male patients. Better prognosis could be due to multiple factors including differing hair, levels of sun exposure, and advanced male age. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Paolo M Arce
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Ettl T, Irga S, Müller S, Rohrmeier C, Reichert TE, Schreml S, Gosau M. Value of anatomic site, histology and clinicopathological parameters for prediction of lymph node metastasis and overall survival in head and neck melanomas. J Craniomaxillofac Surg 2013; 42:e252-8. [PMID: 24216129 DOI: 10.1016/j.jcms.2013.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/02/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Head and neck melanoma compromises a group of aggressive tumours with varying clinical courses. This analysis was performed to find anatomic and clinicopathological parameters predictive for lymph node metastasis and overall survival. MATERIAL AND METHODS Data and outcome of 246 patients with a malignant melanoma in the head and neck region were retrospectively analyzed for predictive parameters. RESULTS Lentigo maligna melanoma (n = 115) was the most frequent histology, followed by superficial spreading (n = 63) and nodular melanoma (n = 52). More than half of the melanomas (n = 138) were in the face. Tumours of the face and anterior scalp metastasized to lymph nodes of the neck and parotid gland, whereas tumours of the posterior scalp and neck also metastasized to the nuchal region. Advanced Clark level, presence of tumour ulceration and younger age were the strongest predictors of lymph node metastasis in multivariate regression analysis (p < 0.05), but anatomic site, histological subtype and tumour thickness were also associated with lymph node metastasis. Lymph node metastases, distant metastases, ulceration, nodular subtype and non-facial site of origin were the strongest negative prognostic parameters for disease-specific overall survival (p < 0.05). In contrast, the width of resection margin (<1 cm vs. 1-2 cm vs. >2 cm) did not correlate with tumour recurrence and overall survival (p > 0.05). CONCLUSION Histological subtype diagnosis, anatomic site of origin as well as the established factors tumour thickness, ulceration and depth of invasion are prognostic indicators of cervical lymph node metastasis and overall survival. A resection margin of at least 1 cm seems sufficient in head and neck melanoma. The status of sentinel lymph node biopsy and neck dissection has to be proven within the next years.
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Affiliation(s)
- Tobias Ettl
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
| | - Serkan Irga
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Steffen Müller
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christian Rohrmeier
- Department of Otorhinolaryngology (Chair: Prof. J. Strutz, MD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Torsten E Reichert
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Stephan Schreml
- Department of Dermatology (Chair: Prof. M. Landthaler, MD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Jones EL, Jones TS, Pearlman NW, Gao D, Stovall R, Gajdos C, Kounalakis N, Gonzalez R, Lewis KD, Robinson WA, McCarter MD. Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result. JAMA Surg 2013; 148:456-61. [PMID: 23325294 DOI: 10.1001/jamasurg.2013.1335] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To analyze the predictors and patterns of recurrence of melanoma in patients with a negative sentinel lymph node biopsy result. DESIGN Retrospective chart review of a prospectively created database of patients with cutaneous melanoma. SETTING Tertiary university hospital. PATIENTS A total of 515 patients with melanoma underwent a sentinel lymph node biopsy without evidence of metastatic disease between 1996 and 2008. MAIN OUTCOME MEASURES Time to recurrence and overall survival. RESULTS Of 515 patients, 83 (16%) had a recurrence of melanoma at a median of 23 months during a median follow-up of 61 months (range, 1-154 months). Of these 83 patients, 21 had melanoma that metastasized in the studied nodal basin for an in-basin false-negative rate of 4.0%. Patients with recurrence had deeper primary lesions (mean thickness, 2.7 vs 1.8 mm; P < .01) that were more likely to be ulcerated (32.5% vs 13.5%; P < .001) than those without recurrence. The primary melanoma of patients with recurrence was more likely to be located in the head and neck region compared with all other locations combined (31.8% vs 11.7%; P < .001). Median survival following a recurrence was 21 months (range, 1-106 months). Favorable characteristics associated with lower risk of recurrence included younger age at diagnosis (mean, 49 vs 57 years) and female sex (9% vs 21% for males; P < .001). CONCLUSION Overall, recurrence of melanoma (16%) after a negative sentinel lymph node biopsy result was similar to that in previously reported studies with an in-basin false-negative rate of 4.0%. Lesions of the head and neck, the presence of ulceration, increasing Breslow thickness, older age, and male sex are associated with increased risk of recurrence, despite a negative sentinel lymph node biopsy result.
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Affiliation(s)
- Edward L Jones
- Department of Surgery, University of Colorado Denver, Aurora, CO 80045, USA
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The prognostic impact of the anatomical sites in the 'head and neck melanoma': scalp versus face and neck. Melanoma Res 2013; 22:402-5. [PMID: 22922466 DOI: 10.1097/cmr.0b013e3283577b96] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous melanoma is a malignant neoplasia with several demographic and histopathological prognostic factors. Many studies stress that the head and neck region has a worse prognosis compared with other localizations, but the reasons for this worse prognosis are unclear. Therefore, the aim of our study is to analyse the poor prognosis of head and neck melanoma (HNM) with respect to the other anatomical sites, considering the face and neck (F&N) and the scalp separately. We carried out a retrospective analysis of 757 melanoma patients. In particular, we studied the prognostic impact of different melanoma skin localizations (head and neck, trunk, upper extremities and lower extremities). Afterwards, we divided HNM into two subgroups, F&N and scalp, to evaluate their impact in the HNM prognosis. Data showed a significantly lower 5-year overall survival probability for HNM (78.9 versus 93.1% for other body sites; P=0.05). Moreover, on analysing the two anatomical areas considered among HNM, we observed a 5-year overall survival of 81.8% for F&N and 66.7% for scalp. HNM has different and worse prognostic features with respect to other sites, but this trend is not only because of scalp melanoma but is also determined by F&N melanoma, which we believe to be underestimated until now.
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Sex-related location of head and neck melanoma strongly argues for a major role of sun exposure in cars and photoprotection by hair. J Invest Dermatol 2013; 133:1205-11. [PMID: 23389395 DOI: 10.1038/jid.2012.405] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Head and neck melanomas (HNMs) are frequent and have a poorer prognosis than melanomas at other sites. Photoprotection in these locations is difficult. In this population-based study of 279 HNMs diagnosed in a French region between 2004 and 2009, major differences were found between genders. A clearcut, sex-related distribution was found between a "peripheral" area (scalp, forehead, temples, ears, and neck) and a "central" one (other parts of the face), with 56.7% of HNMs being located in the peripheral area in men and 79.3% in the central area in women (P<0.0001). Moreover, HNMs located in the peripheral area occurred on the left side in 57.6% of men and on the right side in 73.1% of women (P=0.009). Peripheral HNMs differed from central HNMs by a higher proportion of invasive tumors, nodular or superficial spreading melanomas, and a lower proportion of lentigo maligna melanomas (LMMs). We hypothesized that this differential distribution between men and women could be explained mostly by a major role of long-term photoprotection by hair and sun exposure in a car. Important public health messages could result from these observations, such as the role of hairstyles in melanoma prevention and the importance of reducing sun exposure in a car, particularly in professional drivers.
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Assessing hairdressers' knowledge of scalp and neck melanoma and their willingness to detect lesions and make referrals to dermatologists. J Am Acad Dermatol 2013; 68:183-5. [DOI: 10.1016/j.jaad.2012.06.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 06/27/2012] [Accepted: 06/30/2012] [Indexed: 11/17/2022]
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Roosta N, Wong MK, Woodley DT. Utilizing hairdressers for early detection of head and neck melanoma: an untapped resource. J Am Acad Dermatol 2012; 66:687-8. [PMID: 22421114 DOI: 10.1016/j.jaad.2011.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 09/06/2011] [Accepted: 09/08/2011] [Indexed: 10/28/2022]
Abstract
This commentary raises an important issue that has not been sincerely considered in the field of dermatology, which is the vital role of hairdressers--a group that makes daily observations of the general populations' scalp and neck--in the detection of head and neck melanomas in the general population. We note several key areas of research that are needed to assess the feasibility of using hairdressers as a resource for melanoma detection and referral. If research suggests hairdressers can be trained and are willing to make appropriate referrals then implementing these efforts will likely reduce the increasing disease burden of head and neck melanomas.
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Affiliation(s)
- Neda Roosta
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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23
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Vikey A, Vikey D. Primary malignant melanoma, of head and neck: A comprehensive review of literature. Oral Oncol 2012; 48:399-403. [DOI: 10.1016/j.oraloncology.2011.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 12/20/2011] [Accepted: 12/22/2011] [Indexed: 12/14/2022]
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Suton P, Lukšić I, Müller D, Virag M. Lymphatic drainage patterns of head and neck cutaneous melanoma: does primary melanoma site correlate with anatomic distribution of pathologically involved lymph nodes? Int J Oral Maxillofac Surg 2012; 41:413-20. [DOI: 10.1016/j.ijom.2011.12.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 10/19/2011] [Accepted: 12/19/2011] [Indexed: 10/14/2022]
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Shashanka R, Smitha BR. Head and neck melanoma. ISRN SURGERY 2012; 2012:948302. [PMID: 22570796 PMCID: PMC3337483 DOI: 10.5402/2012/948302] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/24/2012] [Indexed: 12/02/2022]
Abstract
The incidence of malignant melanoma appears to be increasing at an alarming rate throughout the world over the past 30–40 years and continues to increase in the United States, Canada, Australia, Asia, and Europe. The behavior of head and neck melanoma is aggressive, and it has an overall poorer prognosis than that of other skin sites. The authors review the published literature and text books, intending to give an overall picture of malignant melanomas of the head and neck and a special emphasis on treatment considerations with controversies in treatment including biopsy, radiation therapy, sentinel node biopsy, and nodal dissection.
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Affiliation(s)
- R Shashanka
- Department of General Surgery, Hassan Institute of Medical Sciences, Karnataka, Hassan 573201, India
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26
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Komisarovas L, Jayasinghe C, Seah TE, Ilankovan V. Retrospective study on the cutaneous head and neck melanoma in Dorset (UK). Br J Oral Maxillofac Surg 2011; 49:359-63. [DOI: 10.1016/j.bjoms.2010.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 06/18/2010] [Indexed: 11/24/2022]
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Beier US, Salinas T, Puelacher W. Resection of a primary oral malignant melanoma and rehabilitative management using nasolabial flap: a case report. Oral Maxillofac Surg 2011; 16:141-5. [PMID: 21660434 DOI: 10.1007/s10006-011-0281-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 05/27/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND The primary malignant melanoma is a rare neoplasm of melanocytic origin in the oral cavity. Only about 1% of all melanomas arise in the oral mucosa and these account for 0.5% of all oral malignancies CASE REPORT This report describes an oral malignant melanoma occurring in the right maxilla of a 73-year-old patient. The interdisciplinary management using a nasolabial flap and prosthetic oral rehabilitation procedure is described. DISCUSSION The nasolabial flap technique offers the possibility of an immediate reconstruction of the maxillary defect and obviated problems with speech, swallowing, and permitted oral intake. As a supplementary benefit, the resection area can support the prosthetic rehabilitation.
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Affiliation(s)
- Ulrike Stephanie Beier
- Clinical Department of Restorative and Prosthetic Dentistry, Innsbruck Medical University, MZA, Anichstrasse 35, 6020 Innsbruck, Austria.
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28
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[Melanoma of the head and neck region in material of Department of Oncological and Reconstructive Surgery in Center of Oncology IMSC in Gliwice]. Otolaryngol Pol 2010; 64:55-9. [PMID: 21171313 DOI: 10.1016/s0030-6657(10)70011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION About 25% of melanomas are localized in head and neck skin, and this particular localization is most difficult to treat, and the prognosis is less favorable. The depth of melanoma infiltration (Clark and Breslau grade) into the skin is the main factor of local advancement of the disease. Surgical treatment is an essential therapeutic modality in patients with melanoma. AIM The aim of this study was to evaluate results of our surgical treatment of melanomas in head and neck localisation, treated from 1997 to 2007 in Department of Oncological and Reconstructive Surgery in Center of Oncology IMSC in Gliwice. MATERIAL We analysed group of 47 patients (aged 26 to 75 years, mean 49), treated by surgical excision of malignant melanoma in the head and neck region. Most of the patiens required to use free flaps or skin graft technique to close posexcisional defect, on basis of clinical considerations. RESULTS The 5-year total survival for all patients was 62% and were dependent on depht of melanoma infiltration and regional lymph node metastasis. The significant prognostic factors were: localization of primary focus, local progression of disease, free microscopical excision margins sex and age. CONCLUSIONS Prognosis in the patients with melanoma of the head and neck is unreliable and dependent on local advancement of disease and localization of primary focus. Surgical treatment is an essential therapeutic modality in patients with melanoma. Adiuvant radiotherapy after surgical treatment of melanoma of the head and neck is intended for the patiens with high risk of local or regional recurence of disease.
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Marinova L, Yordanov K, Sapundgiev N. Primary mucosal sinonasal melanoma-Case report and review of the literature. The role of complex treatment-surgery and adjuvant radiotherapy. Rep Pract Oncol Radiother 2010; 16:40-3. [PMID: 24376954 DOI: 10.1016/j.rpor.2010.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 11/15/2010] [Indexed: 02/03/2023] Open
Abstract
AIM The place of adjuvant radiotherapy in the treatment of sinonasal melanoma. BACKGROUND Sinonasal mucosal melanoma is a rare disease with poor prognosis and requires a complex treatment. Elective neck dissection in patients with N0 and adjuvant radiotherapy has been a source of controversy. High late regional recurrence rates rise questions about elective irradiation of the neck nodes in patients with N0 stage disease. METHODS We present our two years' follow up in a case of locally advanced sinonasal melanoma and literature review of the treatment options for mucosal melanoma. RESULTS In locally advanced sinonasal melanoma treated with surgical resection, postoperative radiotherapy and chemotherapy we had local tumor control. Two years later, a regional contralateral recurrence without distant metastasis occurred. CONCLUSIONS Literature data for frequent neck lymph nodes recurrences justify elective neck dissection. Postoperative elective neck radiotherapy for patients with locally advanced sinonasal melanoma and clinically N0 appears to decrease the rate of late regional recurrences.
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Affiliation(s)
- Lena Marinova
- Radiotherapy Department, Oncology Hospital, Medical University - Varna, Varna, Bulgaria
| | - Kaloyan Yordanov
- Radiotherapy Department, Oncology Hospital, Medical University - Varna, Varna, Bulgaria
| | - Nikolay Sapundgiev
- Oto-rhyno-laryngology Department, University Hospital "Sveta Marina", Medical University - Varna, Varna, Bulgaria
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Rivera RD, Diamante M, Kasten SJ, Ward BB. Metastatic Melanoma to the Mandible: Case Report and Review of the Literature. J Oral Maxillofac Surg 2010; 68:2903-6. [DOI: 10.1016/j.joms.2010.06.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 05/25/2010] [Accepted: 06/18/2010] [Indexed: 11/28/2022]
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Abstract
Nearly 20% of malignant melanoma in the human body occurs in the head and neck. Most studies divide the sites of origin of malignant melanoma in the head and neck into the following areas: the face, the scalp and neck, the external ear, and the eyelid or medial or lateral canthal area. Sixty-five percent of malignant melanomas occur in the facial region. Given that the face represents only 3.5% of total body surface area, the face is overrepresented when compared with other sites in the head and neck. Among the sites of origin in the head and neck, melanoma of the scalp and neck carries the highest mortality, with 10-year survival being only 60%. Melanomas of the ear, face, and eyelid have 10-year survival rates of 70%, 80%, and 90%, respectively.
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Affiliation(s)
- David L Larson
- Department of Plastic Surgery, Medical College of Wisconsin, 8700 Watertown Plank Road, Milwaukee, WI 53122, USA.
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Use of 18F-fluorodeoxyglucose positron emission tomography in patients with rare head and neck cancers. Clin Exp Otorhinolaryngol 2008; 1:103-9. [PMID: 19434281 PMCID: PMC2671791 DOI: 10.3342/ceo.2008.1.2.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 06/08/2008] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The clinical utility of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been demonstrated in major head and neck cancers (HNCs) but is unclear in rare HNCs. We therefore evaluated FDG PET in the management of patients with rare HNCs. METHODS FDG PET and CT/MRI scanning were performed at the initial staging and/or the follow-up in 24 patients with rare HNCs, 10 with melanoma, 9 with sarcoma, 3 with olfactory neuroblastomas, and 2 with basal cell carcinoma. The diagnostic accuracy of CT and FDG PET for detecting primary tumors and metastases were compared with a histopathologic reference. The association between the PET results and the clinicopathologic parameters predicting tumor invasion, histologic grade and disease-free survival (DFS), was assessed. RESULTS The overall accuracies of FDG PET and CT/MRI were 92% and 79%, respectively, for detecting primary tumors and 91% and 74%, respectively, for nodal metastases, but the differences were not significant due to the small number of patients. The sensitivity and specificity of FDG PET for detecting distant metastases and second primary tumors were 100% and 87%, respectively. Follow-up FDG PET correctly diagnosed locoregional recurrence in all 12 patients, as shown by biopsy, and distant metastases in 6 patients. However, thickness of melanoma, histologic grade of sarcoma, and DFS were not associated with tumor FDG uptake. CONCLUSION FDG PET may be useful for staging, posttreatment monitoring, and detection of distant metastases and second primary tumors in patients with rare HNCs.
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Comparison Among Clark's, Breslow's, and TNM classifications for cutaneous head and neck malignant melanoma. J Craniofac Surg 2008; 18:1353-8. [PMID: 17993881 DOI: 10.1097/scs.0b013e3180534453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This retrospective study was carried out to assess the prognostic value of three classification systems used for staging cutaneous head and neck malignant melanoma (CHNME). Fifty-three patients with histologically proven CHNME were analyzed. Thirty patients were never treated before admission, whereas 23 (43.4%) had a second radical resection of the primary tumor location, 9 (17%) had neck nodes, none had distant metastasis, and all had a minimum of 5 years of follow-up. Results show that T-stage is the most important clinical prognostic parameter, whereas Clark's and Breslow's classifications have lower impact in defining prognosis. Sites of primary tumor determines different clinical outcomes, but this does not reach statistically significant values. A second surgery on the primary tumor location is possible and is effective toward survival. No statistical differences were noted between the previously untreated and treated groups. Neck nodes have to be removed with neck dissection, and this regimen can improve the clinical outcome; however, only 40% of neck positive patients survive more than 5 years.
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Covarelli P, Tomassini GM, Simonetti S, Messina S, Cini C, Petrina A, Noya G. The single-photon emission computed tomography/computed tomography: a new procedure to perform the sentinel node biopsy in patients with head and neck melanoma. Melanoma Res 2007; 17:323-8. [PMID: 17885588 DOI: 10.1097/cmr.0b013e3282ef415b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to define and validate a new technique to detect the sentinel node (SN) in patients treated for head and neck melanoma. In a small series of 23 head and neck melanoma patients, lymphatic mapping was followed by SN biopsy, using in 12 patients a new diagnostic imaging technique, single-photon emission computed tomography/computed tomography. The procedure is described and the major problems encountered are discussed. The preliminary data show that identification of SN using single-photon emission computed tomography/computed tomography never failed in 12 patients, and biopsies performed, compared with those in a standard group, took significantly less time (Mann-Whitney test P=0.006). In conclusion, the authors underline the possibility of a wide use for this technique.
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Affiliation(s)
- Piero Covarelli
- Section of General and Oncologic Surgery, Perugia General Hospital, University of Perugia, Perugia, Italy.
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Milman T, Lambert WC, Mirani N, Langer PD. Lentigo maligna of the eyelid a rare finding in African Americans. Ophthalmology 2007; 114:1409-12. [PMID: 17475333 DOI: 10.1016/j.ophtha.2006.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 10/20/2006] [Accepted: 10/20/2006] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To report the case of a 48-year-old African American man with lentigo maligna of the left lower eyelid. DESIGN Interventional case report. PARTICIPANTS One patient with lentigo maligna of the left lower eyelid. METHODS We report the clinical presentation, histopathologic and immunohistochemical features, and treatment of an African American man with lentigo maligna of the eyelid. The current literature regarding this uncommon neoplasm in African American patients also is reviewed. MAIN OUTCOME MEASURES Histopathologic and immunohistochemical diagnosis and clinical evaluation for recurrence. RESULTS An excisional biopsy revealed lentigo maligna. An extensive literature search revealed no definitive reports of lentigo maligna or lentigo maligna melanoma of the eyelid in an African American patient. CONCLUSIONS Although extremely rare, lentigo maligna may involve ocular adnexal skin in African Americans. Awareness and recognition of this premalignant lesion will aid in early diagnosis and treatment and eventually may improve prognosis.
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Affiliation(s)
- Tatyana Milman
- Department of Pathology, University Hospital, New Jersey Medical School, Newark, New Jersey 07101, USA
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Choi YS, Han GS, Choi JS, Jang TY. Two cases of malignant melanoma in turbinate and maxillary sinus. Eur Arch Otorhinolaryngol 2006; 263:996-1000. [PMID: 16819660 DOI: 10.1007/s00405-006-0103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Accepted: 06/01/2006] [Indexed: 10/24/2022]
Abstract
Malignant melanomas develop from malignant transformation of melanocytes that are present in the skin and mucosal linings throughout the body. The overall rate of mucosal melanoma is rare and malignant melanomas developing from turbinates or maxillary sinuses are extremely rare. Symptoms of nasal melanoma are generally nonspecific, and patients often fail to seek prompt medical attention. Diagnosis can be confirmed by the immunochemical profile of staining with anti-S100 and HMB-45 antibodies, even in the case of melanin-free pigment melanoma. The present study reports two cases of primary malignant melanoma in the turbinate and maxillary sinus.
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Affiliation(s)
- Yoon-Seok Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Inha University, Jung-Gu, Incheon 400-711, South Korea
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