Patterns of failure in patients with cutaneous head and neck melanoma

Gideon Bachar, Sharon Tzelnick, Nimrod Amiti, Haim Gutman

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The incidence of head and neck melanoma is increasing. Various factors influence prognosis. Objective: We sought to investigate the subgroup of patients with head and neck melanoma who fail primary treatment and to define the patterns of failure. Methods: The 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. Results: The 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. Conclusions: The 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.

Original languageEnglish
Pages (from-to)914-917
Number of pages4
JournalEuropean Journal of Surgical Oncology
Volume46
Issue number5
DOIs
StatePublished - May 2020

Keywords

  • Head and neck
  • Malignant melanoma
  • Recurrence
  • Sentinel lymph node

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