Value of anatomic site, histology and clinicopathological parameters for prediction of lymph node metastasis and overall survival in head and neck melanomas.
BACKGROUND
Head and neck melanoma compromises a group of aggressive tumours with varying clinical courses. This analysis was performed to find anatomic and clinicopathological parameters predictive for lymph node metastasis and overall survival.


METHODS
Data and outcome of 246 patients with a malignant melanoma in the head and neck region were retrospectively analyzed for predictive parameters.


RESULTS
Lentigo maligna melanoma (n = 115) was the most frequent histology, followed by superficial spreading (n = 63) and nodular melanoma (n = 52). More than half of the melanomas (n = 138) were in the face. Tumours of the face and anterior scalp metastasized to lymph nodes of the neck and parotid gland, whereas tumours of the posterior scalp and neck also metastasized to the nuchal region. Advanced Clark level, presence of tumour ulceration and younger age were the strongest predictors of lymph node metastasis in multivariate regression analysis (p < 0.05), but anatomic site, histological subtype and tumour thickness were also associated with lymph node metastasis. Lymph node metastases, distant metastases, ulceration, nodular subtype and non-facial site of origin were the strongest negative prognostic parameters for disease-specific overall survival (p < 0.05). In contrast, the width of resection margin (<1 cm vs. 1-2 cm vs. >2 cm) did not correlate with tumour recurrence and overall survival (p > 0.05).


CONCLUSIONS
Histological subtype diagnosis, anatomic site of origin as well as the established factors tumour thickness, ulceration and depth of invasion are prognostic indicators of cervical lymph node metastasis and overall survival. A resection margin of at least 1 cm seems sufficient in head and neck melanoma. The status of sentinel lymph node biopsy and neck dissection has to be proven within the next years.
Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: tobias.ettl@ukr.de.
Tobias
T
Ettl
Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
Serkan
S
Irga
Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
Steffen
S
Müller
Department of Otorhinolaryngology (Chair: Prof. J. Strutz, MD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
Christian
C
Rohrmeier
Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
Torsten E
TE
Reichert
Department of Dermatology (Chair: Prof. M. Landthaler, MD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
Stephan
S
Schreml
Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
Martin
M
Gosau
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D005153:Facial Neoplasms / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D018327:Hutchinson's Melanotic Freckle / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010307:Parotid Neoplasms / Q000556:secondary; D011379:Prognosis; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology*; D015996:Survival Rate; D014456:Ulcer / Q000473:pathology
Head and neck; Melanoma; Neck dissection; Prognosis; Resection margin