Abstract
BackgroundPrevious studies reported cutaneous melanoma in head and neck (HNM) differed from those in other regions (body melanoma, BM). Individualized tools to predict the survival of patients with HNM or BM remain insufficient. We aimed at comparing the characteristics of HNM and BM, developing and validating nomograms for predicting the survival of patients with HNM or BM.MethodsThe information of patients with HNM or BM from 2004 to 2015 was obtained from the Surveillance, Epidemiology, and End Results (SEER) database. The HNM group and BM group were randomly divided into training and validation cohorts. We used the Kaplan-Meier method and multivariate Cox models to identify independent prognostic factors. Nomograms were developed via the rms and dynnom packages, and were measured by the concordance index (C-index), the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and calibration plots.ResultsOf 70,605 patients acquired, 21% had HNM and 79% had BM. The HNM group contained more older patients, male sex and lentigo maligna melanoma, and more frequently had thicker tumors and metastases than the BM group. The 5-year cancer-specific survival (CSS) and overall survival (OS) rates were 88.1 ± 0.3% and 74.4 ± 0.4% in the HNM group and 92.5 ± 0.1% and 85.8 ± 0.2% in the BM group, respectively. Eight variables (age, sex, histology, thickness, ulceration, stage, metastases, and surgery) were identified to construct nomograms of CSS and OS for patients with HNM or BM. Additionally, four dynamic nomograms were available on web. The internal and external validation of each nomogram showed high C-index values (0.785–0.896) and AUC values (0.81–0.925), and the calibration plots showed great consistency.ConclusionsThe characteristics of HNM and BM are heterogeneous. We constructed and validated four nomograms for predicting the 3-, 5- and 10-year CSS and OS probabilities of patients with HNM or BM. These nomograms can serve as practical clinical tools for survival prediction and individual health management.
Highlights
Previous studies reported cutaneous melanoma in head and neck (HNM) differed from those in other regions
Many studies have reported that anatomic location is an important prognostic factor for primary cutaneous melanoma [3,4,5], and head and neck melanoma (HNM) should be treated differently from melanoma in other regions [6,7,8,9]
> 4.0 mm HNM head and neck melanoma, Body melanoma (BM) body melanoma, NM nodular melanoma, lentigo maligna melanoma (LMM) Lentigo maligna melanoma, Superficial spreading melanoma (SSM) superficial spreading melanoma, hazard ratios (HR) hazard ratio, 95% confidence intervals (CIs) 95% confidence interval, CSS cancer-specific survival, OS overall survival a Other: International Classification of Diseases for Oncology-O-3, codes 8722–8723, 8730, 8740–8741, 8744–8746, 8761, 8770–8774, 8780
Summary
Previous studies reported cutaneous melanoma in head and neck (HNM) differed from those in other regions (body melanoma, BM). Individualized tools to predict the survival of patients with HNM or BM remain insufficient. In the United States, the incidence of cutaneous melanoma continues to rise, and the 5-year relative survival rate is 92% (2009–2015) [2]. Many studies have reported that anatomic location is an important prognostic factor for primary cutaneous melanoma [3,4,5], and head and neck melanoma (HNM) should be treated differently from melanoma in other regions (body melanoma, BM) [6,7,8,9]. Some studies have reported poorer survival in HNM patients [12, 13]
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