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Melanoma prognosis is usually based on Breslow thickness, Clark level, ulceration, nodal and distant metastases, and lactic dehydrogenase level. The influence of anatomic site is less certain. In this retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) melanoma database, the authors analyzed survival rates by anatomic site in 51,704 white, non-Latino patients with a first invasive melanoma diagnosed from 1993 through 2003. To isolate the effect of anatomic site, the authors used multivariate analysis to eliminate the effects of age, sex, Breslow thickness, ulceration, and lymph node status.
On average, compared with melanomas situated elsewhere, lesions of the scalp and neck occurred in older patients (59 vs. 55 years), were thicker (0.80 vs. 0.63 mm), were more likely to be ulcerated (7% vs. 5%), and were more likely to be associated with positive nodes at presentation (7% vs. 4%). Kaplan-Meier survival rates were significantly lower in patients with scalp and neck lesions than in those with lesions elsewhere (83% vs. 92% at 5 years, and 76% vs. 89% at 10 years). Scalp and neck melanomas accounted for 6% of the melanomas in the database but 10% of the melanoma deaths. After multivariable adjustment, patients with scalp and neck lesions were 1.84 times more likely to die from their melanomas, and patients with melanomas on the trunk were 1.27 times more likely to die from their melanomas, than were patients with melanomas located elsewhere.
Lachiewicz AM et al. Survival differences between patients with scalp or neck melanoma and those with melanoma of other sites in the Surveillance, Epidemiology, and End Results (SEER) program. Arch Dermatol 2008 Apr; 144:515.
Comment
Independent of other known prognostic factors, location on the scalp and neck, and, to a lesser degree, on the trunk, seems to predict more-aggressive melanoma than location at other sites. There is no satisfactory explanation for this difference. Clearly, careful scalp examination with the help of a comb or other aid during skin examination is important for early diagnosis in high-risk patients.