title: Sentinel lymph node status is the most important prognostic factor in patients with melanoma of the scalp.
abstract: OBJECTIVE
  To compare clinicopathologic and prognostic factors associated with scalp melanomas and nonscalp 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 and overall survival were performed.
  
  
  RESULTS
  Of 405 patients with H&N melanomas ≥1.0 mm Breslow thickness, 109 patients had melanoma of the scalp. All were Caucasian (100%), with most being male (79.5%) with a mean age of 49.8 years. The mean Breslow thickness was 2.4 mm; 25% had signs of ulceration. Sentinel lymph node (SLN) positivity was seen in 20.9% of scalp melanoma patients, and was more likely in younger patients (44.7 vs. 50.8 years, P = .04) and in those with a Breslow thickness of 2 to 4 mm (P = .005). The incidence of locoregional and distant recurrence were similar. Overall survival for scalp melanoma patients was significantly impacted by SLN positivity (P = .03), whereas Breslow thickness and ulceration status predicted poorer survival in nonscalp melanoma patients (P = .005, P < .0001, respectively).
  
  
  CONCLUSIONS
  In the Sunbelt Melanoma Trial, SLN status was the strongest predictor of overall survival in scalp melanoma. Tumor thickness and ulceration correlated with poorer overall survival in nonscalp H&N melanoma. The prognostic significance of SLN status in the H&N may vary with the melanoma site.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Cappello
authors.forename: Adam C
authors.initials: AC
authors.lastname: Augenstein
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Potts
authors.forename: Kelly M
authors.initials: KM
authors.lastname: McMasters
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Bumpous
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary; D008875:Middle Aged; D009333:Neck; D009364:Neoplasm Recurrence, Local; D009656:North America / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012535:Scalp; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult