title: Patterns of failure and predictors of outcome in cutaneous malignant melanoma of the scalp.
abstract: BACKGROUND
  Patients with melanoma of the scalp may have higher failure (recurrence) rates than melanoma of other body sites.
  
  
  OBJECTIVE
  We sought to characterize survival and patterns of failure for patients with scalp melanoma.
  
  
  METHODS
  Between 1998 and 2010, 250 nonmetastatic patients underwent wide local excision of a primary scalp melanoma. Kaplan-Meier analyses were performed to evaluate overall survival, scalp control, regional neck control, distant metastases-free survival, and disease-free survival.
  
  
  RESULTS
  Five-year overall survival was 86%, 57%, and 45% for stages I, II, and III, respectively, and 5-year scalp control rates were 92%, 75%, and 63%, respectively. Five-year distant metastases-free survival for these stages were 92%, 65%, and 45%, respectively. Of the 74 patients who recurred, the site of first recurrence included distant disease in 47%, although 31% recurred in the scalp alone.
  
  
  CONCLUSIONS
  This is a retrospective review.
  
  
  CONCLUSIONS
  Distant metastases-free survival and overall survival for stage II and III patients with scalp melanoma are poor, and stage III patients experience relatively high rates of scalp failure suggesting that these patients may benefit from additional adjuvant systemic and local therapy. Further research is needed to characterize the environmental, microenvironmental, and genetic causes of the increased aggressiveness of scalp melanoma and to identify more effective treatment and surveillance methods.
authors.affiliation: Department of Radiation Oncology, University of Utah, Salt Lake City, Utah.
authors.forename: Breanne E
authors.initials: BE
authors.lastname: Terakedis
authors.affiliation: Department of Radiation Oncology, University of Utah, Salt Lake City, Utah. Electronic address: chris.anker@hci.utah.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Anker
authors.affiliation: Department of Dermatology, Oregon Health Sciences University, Center for Health and Healing, Portland, Oregon.
authors.forename: Sancy A
authors.initials: SA
authors.lastname: Leachman
authors.affiliation: Department of Surgery, University of Utah, Salt Lake City, Utah.
authors.forename: Robert H I
authors.initials: RH
authors.lastname: Andtbacka
authors.affiliation: Department of Dermatology, University of Utah, Salt Lake City, Utah.
authors.forename: Glen M
authors.initials: GM
authors.lastname: Bowen
authors.affiliation: Department of Radiation Oncology, Intermountain Medical Center, Murray, Utah.
authors.forename: William T
authors.initials: WT
authors.lastname: Sause
authors.affiliation: Department of Medicine, University of Utah, Salt Lake City, Utah.
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Grossmann
authors.affiliation: Department of Surgery, Intermountain Medical Center, Murray, Utah.
authors.forename: Tawnya L
authors.initials: TL
authors.lastname: Bowles
authors.affiliation: Department of Surgery, Intermountain Medical Center, Murray, Utah.
authors.forename: R Dirk
authors.initials: RD
authors.lastname: Noyes
authors.affiliation: Department of Radiation Oncology, University of Utah, Salt Lake City, Utah.
authors.forename: Ying J
authors.initials: YJ
authors.lastname: Hitchcock
authors.affiliation: Department of Oncological Sciences, University of Utah, Salt Lake City, Utah.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Boucher
authors.affiliation: Department of Radiation Oncology, University of Utah, Salt Lake City, Utah.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Shrieve
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012535:Scalp; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis
keywords: melanoma; patterns of failure; recurrence; scalp; survival