Head and neck melanoma: outcome and predictors in a population-based cohort study

Steffen Spoerl,Silvia Spoerl,René Fischer,Michael Gerken,Gerrit Spanier,Torsten E Reichert,Jirka Grosse,Elena Reiter,Christoph Klingelhöffer,Sebastian Haferkamp,Konstantin Drexler,Tobias Ettl,Monika Klinkhammer-Schalke

doi:10.1186/s13005-021-00295-x

Abstract

BackgroundTo evaluate predictive clinico-pathological characteristics on outcome in head and neck melanoma (HNM) in a population-based study with particular emphasis on the prognostic effect of sentinel lymph node biopsy (SLNB), Charlson comorbidity index (CCI) and distinct tumor localisations.MethodsHere we primarily describe a retrospective multicenter population-based cohort study with 402 patients having undergone resection with curative intent of HNM between 2010 and 2017. SLNB was used in the diagnosis of 79 HNM patients. Outcome was analyzed, focusing on SLNB, CCI as well as tumor localisation. Overall survival (OAS) und recurrence free survival (RFS) was examined by uni- and multivariate analysis.ResultsHistopathologically verified lymph node metastasis according to SLNB was associated with impaired RFS in HNM patients (p = 0.004). Especially in higher tumor stages, the sole implementation of SLNB improved survival significantly in the present cohort (p = 0.042). With most of the HNM being located in the face, melanoma of the scalp and neck could be linked to deteriorated patient’s outcome in uni- as well as multivariate analysis (p = 0.021, p = 0.004).ConclusionsSLNB is a useful tool in predicting development of distant metastasis after HNM resection with curative intent. Especially in higher tumor stages, performing a SLNB ameliorated survival of HNM patients. Additionally, CCI as well as a distinct tumor localisations in HNM were identified as important risk factors in our population-based cohort study.

Highlights

To evaluate predictive clinico-pathological characteristics on outcome in head and neck melanoma (HNM) in a population-based study with particular emphasis on the prognostic effect of sentinel lymph node biopsy (SLNB), Charlson comorbidity index (CCI) and distinct tumor localisations
For recurrence free survival (RFS), the harmful impact of histopathologically verified lymph node metastasis by SLNB could, similar to Overall survival (OAS), be substantiated in univariate analysis (HR = 14.442, 95% Confidence interval (CI) = 6.974–29.906, p < 0.001) (Fig. 4B, Tab. 2)
HNM located in the face were significantly associated with impaired OAS and RFS, compared to scalp and neck melanoma (HR = 0.625, 95% CI = 0.419–0.931, p = 0.021, Fig. 5A) (HR = 2.482, CI = 1.524–4.042, p < 0.001, Fig. 5B)

Summary

Introduction

To evaluate predictive clinico-pathological characteristics on outcome in head and neck melanoma (HNM) in a population-based study with particular emphasis on the prognostic effect of sentinel lymph node biopsy (SLNB), Charlson comorbidity index (CCI) and distinct tumor localisations. Especially for earlier stages of HNM patients, alternative therapies to perform an elective neck dissection (END), which often results in postoperative adverse events, were searched In this context, sentinel lymph node biopsy (SLNB) successfully identified. In the MSLT trial, an international multicenter trial being initiated in 1994, the role of clinically and radiologically based nodal observation after resection with curative intent or concomitant SLNB with primary tumor resection was evaluated in intermediate thickness melanoma. In this regard, SLNB was identified as a powerful staging tool with a profound prognostic value for survival of melanoma patients [6]

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Results

Discussion

Conclusion