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Stages II, III scalp melanoma patients experienced poor overall survival

Patients with stages II and III scalp melanoma had poor distant metastases-free, disease-free and overall survival rates at 5 years, according to recent study results.

Sancy A. Leachman, MD, PhD, chair of the department of dermatology, Oregon Health and Science University School of Medicine, and colleagues studied 250 nonmetastatic patients (median age at diagnosis, 67 years; 86% men) who underwent wide local excision of primary scalp melanoma between 1998 and 2010. Overall survival (OS), scalp control, regional neck control, distant metastases-free survival (DMFS) and disease-free survival (DFS) were measured through Kaplan-Meier analyses.

 

Sancy A. Leachman

Locations of the initial scalp melanomas included crown/vortex (36%), occipital/posterior (19%), parietal (16%), frontal/forehead (16%) and other/unknown (13%).

Overall 5-year survival rates were: stage I, 86%; stage II, 57% and stage III, 45%. Five-year scalp control rates were: stage I, 92%; stage II, 75% and stage III, 63%. For each stage, 5-year DMFS rates were: 92%, 65% and 45%, respectively; while 5-year DFS rates were: 61%, 54% and 25%, respectively.

Seventy-four patients (30%) experienced recurrence, with the site isolated to the scalp in 23 patients (31%); neck, 12 patients; distant sites, 22 patients; and greater than one region, 17 patients. Thirty-five patients (47%) were diagnosed with distant metastatic disease at first recurrence.

The researchers considered the study’s retrospective design and lack of full systemic therapy records as limitations.

“DMFS and OS for stage II and III patients are poor, and these patients may benefit from more aggressive adjuvant systemic therapy,” the researchers concluded. “Because of a relatively high rate of isolated scalp failures, novel scalp treatment methods may be beneficial for stage III patients.

“Scalp melanoma is an aggressive malignancy and may represent a subcategory of melanoma, such as acral lentiginous and mucosal melanoma, deserving of special clinical consideration.”

Disclosure: See the study for a full list of relevant disclosures.