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Breslow thickness, male predominance contribute to poorer survival of scalp melanoma
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Poorer survival of scalp melanoma is associated with greater Breslow thickness and a higher proportion of male patients, according to study results recently published in the Journal of the American Academy of Dermatology.
Researchers conducted a retrospective cohort study of 900 patients with invasive cutaneous head and neck melanoma (CNHM) seen between October 1994 and February 2014 at a tertiary referral center at the Alfred Hospital in Melbourne, Australia. They compared melanoma-specific survival between scalp melanoma and other CHNM.
Among the patients, there were 237 (26.3%) with scalp melanoma, 386 (42.9%) with face melanoma, 174 (19.3%) with neck melanoma and 103 (11.4%) with ear melanoma.
“Several characteristics differed between patients with scalp melanoma and other CHNM, in particular, the scalp melanoma group had a higher proportion of male patients, thicker tumors and more tumors with lymphovascular invasion, neurotropism and satellite metastases,” the researchers wrote.
Patients with scalp melanoma had worse melanoma-specific survival compared with the other types of CHNM (HR = 2.22; 95% CI, 1.59-3.11). Multivariable analysis found that scalp location was not associated with melanoma-specific survival in CHNM for all tumors (HR = 1.11; 95% CI, 0.77-1.61). However, in analysis of tumors within individual Breslow thickness strata, scalp location was independently associated with melanoma-specific survival for the 0.76- to 1.50-mm thickness stratum (HR = 5.51; 95% CI, 1.55-19.59). Scalp location had no association with melanoma-specific survival for 1.51- to 4-mm CHNM (HR = 0.96; 95% CI, 0.46-2.02).
Besides Breslow thickness, lymphovascular invasion, male sex and tumor ulceration were associated with melanoma-specific survival in CHNM.
“Scalp melanoma has poorer survival than other CHNM. This appears to be largely because of the higher Breslow thickness and predominance of male patients who are associated with scalp melanoma,” the researchers concluded. “However, scalp melanoma was independently associated with poorer [melanoma-specific survival] for 0.76- to 1.50-mm CHNM in this study. Considering distinctive and atypical clinical presentations, high-risk histologic features and poorer survival (particularly for 0.76 to 1.50 mm-thick tumors) associated with scalp melanoma, it deserves special attention.” – by Bruce Thiel
Disclosure: The researchers report no relevant financial disclosures.
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