Patterns of failure in patients with cutaneous head and neck melanoma |
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| Affiliation: | 1. Department of Otolaryngology, Head and Neck Surgery, Beilinson Hospital, Petach Tikva, Israel;2. Surgical Oncology Unit, Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel;3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;1. Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden;2. Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden;1. Service of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, 1011, Lausanne, Switzerland;2. Medical Oncology Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland;3. Institute of Pathology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland;4. Radiation Oncology Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland;5. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland;6. Department of Plastic and Reconstructive Surgery, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland;7. Departments of Surgery and Oncology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland;8. Orthopedic Department, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland;1. Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN;2. Department of Surgery, Mayo Clinic, Rochester, MN;3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN;4. Department of Medical Oncology, Mayo Clinic, Rochester, MN;1. Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy;2. Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Italy;1. Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy;2. Catholic University of the Sacred Heart, Italy;1. National University of Singapore, Singapore;2. National University Hospital, Singapore;3. Tan Tock Seng Hospital, Singapore |
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| Abstract: | IntroductionThe incidence of head and neck melanoma is increasing. Various factors influence prognosis.ObjectiveWe sought to investigate the subgroup of patients with head and neck melanoma who fail primary treatment and to define the patterns of failure.MethodsThe database of a tertiary medical center was reviewed for patients diagnosed and surgically treated for cutaneous head and neck melanoma in 1995–2014. Regional disease failure was defined as disease confirmed in positive SLNB at first assessment or at recurrence.ResultsThe cohort included 141 patients followed for a median duration of 6.8 years (range 1–20 years). Median tumor thickness was 2.1 mm (range 0.5–12 mm). Ulceration was documented in 38 patients (26.9%). Sentinel lymph node biopsy (SLNB) was positive in 18 patients (12.8%). Total disease failure rate was 32.6% with similar rates of regional (n = 26, 18.4%) and distal (n = 22, 15.6%) failure. Most patients (86.3%) with systemic recurrence had a negative SNLB as did 6/26 patients (23%) with regional failure. Forty-three patients (30.4%) died during follow-up, half of them (23 patients, 16.3%) of melanoma. On multivariate analysis, Breslow thickness was the only significant predictor of outcome.ConclusionsThe pattern of treatment failure in patients with head and neck melanoma relate predominantly to Breslow thickness. The high false-negative rate of SNLB and the relatively high rate of systemic failures in patients with negative SNLB indicate a low predictive value of this procedure. Efforts to detect systemic disease during follow-up need to be intensified. |
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| Keywords: | Malignant melanoma Sentinel lymph node Head and neck Recurrence |
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