Head and neck melanoma in the sentinel lymph node era

Objective: To determine whether, in the era of sentinel lymph node (SLN) biopsy, head and neck melanoma (HNM) has a poorer outcome than melanomas at other sites (OMS). Design: Prospective database, 1994 to 2004. Characteristics and outcomes of patients with HNM vs; those with OMS were analyzed by Fisher test, paired t test, and chi(2) test. Setting: Tertiary referral center. Patients: A total of 755 patients with melanoma who had undergone SLN biopsy. Main Outcome Measures: Differences between patients with HNM and those with OMS. Results: A total of 17.4% of patients had HNM vs 82.6% with OMS. There was a male HNM preponderance: 68.7% vs 50.3% for females (P <.01). Patients with HNM were older (mean [SD] age, 57.1 [16.6] years vs 53.3 [16.2] years; P<.01). There were fewer cases of superficial spreading melanoma in patients with HNM (29.0% vs 53.7%; P<.01). There were more diagnoses of lentigo maligna in patients with HNM (26.0% vs 1.9%; P<.01). The mean thickness of the primary lesion was 2.32 (1.9) mm vs 2.31 (2.9) mm; P=.49. Fewer patients with HNM had Clark level involvement lower than level IV (13.3% vs 24.0%; P <.01). More SLNs were harvested from patients with HNM (3.72 [3.2] vs 2.89 [2.6]; P<.01), but a lower percentage of positive SLNs was found (9.2% vs, 16.0%; P<.05). There was no difference in local, regional, or distant recurrence (5.3%, 6.9%, and 5.3%, respectively, in patients with HNM and 3.4%, 5.5%, and 6.7%, respectively, in patients with OMS). The 2- and 5-year survival rates for patients with HNM were 96.2% and 72.6%, respectively, vs 93.6% and 79.0%, respectively, in patients with OMS (P=.40). Conclusions: Most patients with HNM are older males with more SLNs harvested. They do not seem to have poorer outcome than patients with OMS.