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. 2022 Mar;88(3):480-488.
doi: 10.1177/00031348211050813. Epub 2021 Nov 11.

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience

Kirsten M Baecher  1 , Michael K Turgeon  1 , Caroline R Medin  1 , Geetha Mahendran  1 , Terrill M Flakes  1 , Keith A Delman  1 , Michael C Lowe  1
Affiliations

Do Oncologic Outcomes From Head and Neck Versus Truncal and Extremity Melanoma Differ? A Single-Institution Single-Subspecialty Experience

Kirsten M Baecher et al. Am Surg. 2022 Mar.

Abstract

Background: Outcomes are thought to be worse in head and neck (H&N) melanoma patients. However, definitive evidence of inferior outcomes in H&N melanoma in the modern era is lacking. We sought to ascertain whether H&N melanomas carry a worse prognosis than melanomas of other sites.

Methods: All patients who underwent excision for primary melanoma by fellowship-trained surgical oncologists at a single institution from 2014 to 2020 were queried from the electronic medical record. Patients who had AJCC eighth edition stage I-III disease were included.

Results: Of 1127 patients, 28.7% had primary H&N melanoma. H&N patients were more likely to be male, older, and present with more advanced AJCC stage. Median follow-up was 20.0 months (IQR 26.4). On multivariable analyses controlling for other variables, H&N melanoma was associated with worse RFS. Notably, H&N melanoma was not associated with worse MSS, DMFS, or OS on univariate or multivariable analyses. Among patients who recurred, H&N patients were significantly more likely to recur locally compared to non-H&N patients. On subgroup analysis, scalp melanoma was also associated with worse RFS compared to patients with melanoma in locations other than the scalp. When patients with scalp melanoma were excluded from analysis, non-scalp H&N RFS was not significantly different from the non-H&N group on univariate or multivariable analyses.

Discussion: In this series from a high-volume tertiary referral center, the differences in rates and sites of recurrence between H&N and non-H&N melanoma do not impact melanoma-specific or overall survival, suggesting that H&N melanoma patients should be treated similarly with respect to regional and systemic therapies.

Keywords: Head/neck; melanoma.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curves. (A) RFS is inferior in head and neck (H&N) vs non-H&N patients; (B) MSS is equivalent in H&N vs non-H&N patients; (C) DMFS is equivalent in H&N vs non-H&N patients; (D) OS is equivalent in H&N vs non-H&N patients; (E) RFS is inferior in scalp patients compared to non-scalp H&N and non-H&N patients.
Figure 1.
Figure 1.
Kaplan-Meier curves. (A) RFS is inferior in head and neck (H&N) vs non-H&N patients; (B) MSS is equivalent in H&N vs non-H&N patients; (C) DMFS is equivalent in H&N vs non-H&N patients; (D) OS is equivalent in H&N vs non-H&N patients; (E) RFS is inferior in scalp patients compared to non-scalp H&N and non-H&N patients.
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