title: The importance of ulceration of cutaneous melanoma of the head and neck: a comparison of ear (pinna) and nonear sites.
abstract: OBJECTIVE
  To compare clinicopathologic and prognostic factors associated with ear melanomas and nonear melanomas of the head and neck (H&N).
  
  
  METHODS
  Post hoc analysis of the database from a multi-institutional, prospective, randomized study.
  
  
  METHODS
  Clinicopathologic factors were assessed and correlated with survival and recurrence. Univariate and multivariate analysis of prognostic factors affecting disease-free survival (DFS) and overall survival (OS) were performed.
  
  
  RESULTS
  Of 405 patients with H&N melanomas ≥ 1.0 mm Breslow thickness, 59 patients had melanomas of the ear. Most were Caucasian (96.6%) males (79.7%) with a mean age of 52 years. The mean Breslow thickness was 2.5 mm; 34.5% had signs of ulceration. Sentinel lymph node (SLN) positivity was seen in 7.1%. The incidence of locoregional and distant recurrence were similar. OS for ear melanoma was significantly impacted by ulceration status (P = .013), whereas both ulceration and SLN positivity predicted survival in nonear melanoma (P < .001 and P = .015, respectively). Thicker melanomas in the nonear group demonstrated significantly decreased DFS, whereas other factors in both groups lost their predictive value (P = .035).
  
  
  CONCLUSIONS
  In the Sunbelt Melanoma Trial, ulceration was the strongest predictor of overall survival in melanoma of the ear. Ulceration and SLN status correlated with poorer OS in nonear melanoma of the H&N, whereas increasing depth correlated with poorer DFS in those same patients. Recurrence and survival were not impacted by anatomic site, but the prognostic significance of ulceration, thickness, and SLN status in the H&N may vary with the site of the melanoma.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Augenstein
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Capello
authors.forename: Jarrod A
authors.initials: JA
authors.lastname: Little
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bumpous
mesh_terms: D001706:Biopsy; D004428:Ear Neoplasms / Q000473:pathology*; D004431:Ear, External / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009656:North America; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology*; D012883:Skin Ulcer / Q000473:pathology*; D015996:Survival Rate