title: Mucosal melanoma of the head and neck: predictors of prognosis.
abstract: OBJECTIVE
  To identify significant clinical and pathological predictors of survival in mucosal melanoma of the head and neck.
  
  
  METHODS
  Retrospective case series. We reviewed cases of mucosal melanoma of the head and neck from a prospectively collected database after institutional review board approval.
  
  
  METHODS
  A single academic institution.
  
  
  METHODS
  Fifty-two patients with mucosal melanoma of the head and neck.
  
  
  RESULTS
  With a median follow-up of 97 months, the median overall survival was 52 months, with a 5-year overall survival of 38%. The median disease-free survival was 15 months, with a 5-year disease-free survival of 22%. Younger age (P = .02), lower T status (P = .003), and lower American Joint Committee on Cancer stage (P < .001) were associated with better overall survival. Positive surgical margins predicted poorer overall survival (P = .01), but patients who required reexcision to achieve negative margins had outcomes that were not significantly different from those with initially negative surgical margins (P = .71). Sex, smoking history, and primary site did not affect disease-free or overall survival. Adjuvant radiotherapy and/or chemotherapy did not predict improved outcomes. Fewer mitoses (P = .02) and the absence of ulceration (P = .01) predicted improved overall survival.
  
  
  CONCLUSIONS
  Our experience confirms the utility of current staging systems in predicting outcomes of mucosal melanoma of the head and neck and stresses the importance of achieving negative surgical margins. Pathologically, fewer mitoses and the absence of ulceration predict better outcomes and should be reported as part of routine histological profiles of mucosal melanoma. Further studies are necessary to change the paradigm of care for this rare and deadly disease.
authors.affiliation: Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, MI 48109, USA. cbradfor@umich.edu
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shuman
authors.forename: Emily
authors.initials: E
authors.lastname: Light
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Olsen
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pynnonen
authors.forename: Jeremy M G
authors.initials: JM
authors.lastname: Taylor
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Johnson
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
mesh_terms: D000368:Aged; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D009061:Mouth Mucosa / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D020545:Respiratory Mucosa / Q000473:pathology*; D016019:Survival Analysis