title: Tumor location predicts survival in cutaneous head and neck melanoma.
abstract: BACKGROUND
  Prior studies documented poorer outcomes in patients with cutaneous head and neck melanoma (CHNM) relative to those with melanoma at other sites. We evaluated survival differences attributable to tumor location in patients with CHNM.
  
  
  METHODS
  We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients undergoing surgery for CHNM from 1988 to 2006, excluding patients without biopsy-proven diagnoses, those diagnosed at autopsy, and patients with distant metastases. Using the Kaplan-Meier method, we assessed patient, tumor, and treatment-specific factors on overall survival (OS) and melanoma specific survival (MSS). Cox proportional hazards models assessed the role of tumor location (ear, eyelid, face, lip, scalp/neck) on OS and MSS, while controlling for patient age, gender, race, tumor thickness, tumor ulceration, lymph node status, histologic subtype, type of surgery, and use of radiation. Risks of overall and melanoma-specific mortality were reported as hazard ratios (HR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Among 27,097 patients, 10-y rates of OS and MSS were 56.1% and 84.7%, respectively. On multivariate analysis, scalp/neck primary site was associated with an increased risk of overall (HR 1.20, CI 1.14-1.26; P < 0.001) and melanoma-specific mortality (HR 1.64, CI 1.49-1.80, P < 0.001) relative to melanomas of the face. Tumors of the lip had poorer MSS (HR 1.55; CI 1.05-2.28, P = 0.03) but not OS (HR 1.03, CI 0.80-1.34; P = 0.80).
  
  
  CONCLUSIONS
  Patients with melanomas of the scalp/neck have poorer OS and MSS and those with lip melanomas have poorer MSS. These anatomic areas should not be overlooked when performing skin examinations.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of California Davis, Sacramento, California, USA.
authors.forename: Warren H
authors.initials: WH
authors.lastname: Tseng
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
mesh_terms: D000368:Aged; D005145:Face; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008046:Lip; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality*; D009333:Neck; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D012535:Scalp; D012878:Skin Neoplasms / Q000175:diagnosis / Q000401:mortality*; D014481:United States