title: Is head and neck melanoma different from trunk and extremity melanomas with respect to sentinel lymph node status and clinical outcome?
abstract: BACKGROUND
  Previous studies showed conflicting and inconsistent results regarding the effect of anatomic location of the melanoma on sentinel lymph node (SLN) positivity and/or survival. This study was conducted to evaluate and compare the effect of the anatomic locations of primary melanoma on long-term clinical outcomes.
  
  
  METHODS
  All consecutive cutaneous melanoma patients (n=2,079) who underwent selective SLN dissection (SLND) from 1993 to 2009 in a single academic tertiary-care medical center were included. SLN positive rate, disease-free survival (DFS), and overall survival (OS) were determined. Kaplan-Meier survival, univariate, and multivariate analyses were performed to determine predictive factors for SLN status, DFS, and OS.
  
  
  RESULTS
  Head and neck melanoma (HNM) had the lowest SLN-positive rate at 10.8% (16.8% for extremity and 19.3% for trunk; P=0.002) but had the worst 5-year DFS (P<0.0001) and 5-year OS (P<0.0001) compared with other sites. Tumor thickness (P<0.001), ulceration (P<0.001), HNM location (P=0.001), mitotic rate (P<0.001), and decreasing age (P<0.001) were independent predictive factors for SLN-positivity. HNM with T3 or T4 thickness had significantly lower SLN positive rate compared with other locations (P≤0.05). Also, on multivariate analysis, HNM location versus other anatomic sites was independently predictive of decreased DFS and OS (P<0.001). By Kaplan-Meier analysis, HNM was associated significantly with the worst DFS and OS.
  
  
  CONCLUSIONS
  Primary melanoma anatomic location is an independent predictor of SLN status and survival. Although HNM has a decreased SLN-positivity rate, it shows a significantly increased risk of recurrence and death as compared with other sites.
authors: Center for Melanoma Research & Treatment, California Pacific Medical Center, San Francisco, CA, USA.
authors: Niloofar
authors: N
authors: Fadaki
authors: Rui
authors: R
authors: Li
authors: Brian
authors: B
authors: Parrett
authors: Grant
authors: G
authors: Sanders
authors: Suresh
authors: S
authors: Thummala
authors: Lea
authors: L
authors: Martineau
authors: Servando
authors: S
authors: Cardona-Huerta
authors: Suzette
authors: S
authors: Miranda
authors: Shih-Tsung
authors: ST
authors: Cheng
authors: James R
authors: JR
authors: Miller
authors: Mark
authors: M
authors: Singer
authors: James E
authors: JE
authors: Cleaver
authors: Mohammed
authors: M
authors: Kashani-Sabet
authors: Stanley P L
authors: SP
authors: Leong
mesh_terms: D005121:Extremities / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D062606:Tertiary Care Centers