Head and Neck Melanoma in 534 Clinical Stage I Patients

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Abstract
Single and multifactorial analyses were used to evaluate prognosis and results of surgical treatment in 534 clinical stage I patients with head and neck cutaneous melanoma. This computerized data base was prospectively accumulated in over 90% of cases. Melanomas were about equally distributed between men and women. They were located on the skin of the face in 47%, neck in 27%, scalp in 13% and the ear in 13% of patients. Both the results of the prognostic factors analyses and the surgical treatment demonstrated that lentigo maligna melanoma (LMM) was distinct from the other 2 growth patterns, superficial spreading melanoma and nodular melanoma (SSM and NM). In a multifactorial analysis of the 453 patients with SSM and NM, the dominant prognostic variables were tumor thickness (P < 0.00001), anatomic subsite (P = 0.0213) and ulceration (P = 0.0289). Patients with melanomas on the scalp or neck subsites fared worse than those with tumors located on the face or ear. The results differed for LMM, where thickness was not a significant predictor of survival, and the most dominant prognostic variable was ulceration (P = 0.0042). Local recurrence rates were low, being 2.4% for tumors < 2.5 mm in thickness, but were 12.3% for tumors .gtoreq. 4.0 mm in thickness. Patients with SSM and NM lesions located on the head and neck had a lower survival rate than those with extremity melanomas in every tumor thickness category, although only those in the 0.76 to 1.49 mm thickness subgroup were significantly different (P = 0.0007). After 5 yr of follow-up, patients who underwent an elective lymph node dissection for SSM and NM with a thickness range of 1.5-3.99 mm had a better survival (72%) than patients with melanomas of equivalent thickness whose initial treatment was wide excision alone (45%). LMM had a less aggressive biologic behavior compared to SSM or NM and was treated more conservatively. LMM lesions had an 85% 10-yr survival rate with wide excision only, and there was no significant improvement in survival with ELND [elective regional lymph node dissection]. Growth patterns, tumor thickness, ulceration and anatomic subsites should be considered when evaluating risk foctors and when making treatment decisions in head and nek melanoma patients.