Neck Melanoma Research Articles

Technologic (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region.

Sentinel lymph node (SN) biopsy (SNB) has proven to be a valuable tool for staging melanoma patients. Since its introduction in the early 1990s, this procedure has undergone several technologic refinements, including the introduction of SPECT/CT, as well as radioguidance and fluorescence guidance. The purpose of the current study was to evaluate the effect of this technologic evolution on SNB in the head and neck region. The primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN, and postoperative complications. Methods: A retrospective database was queried for cutaneous head and neck melanoma patients who underwent SNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided into 4 groups: 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a γ-ray detection probe and patent blue (n = 30); 2006-2007, with addition of preoperative road maps based on SPECT/CT (n = 15); 2008-2009, with intraoperative use of a portable γ-camera (n = 40); and 2010-2016, with addition of near-infrared fluorescence guidance (n = 192). Results: In total, 277 patients were included. At least 1 SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%): 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%), and 40 in group 4 (20.8%). Regional recurrences in patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (group 1, 16.7%; group 2, 0%; group 3, 14.3%; group 4, 11.1%). The number of harvested nodes increased with advancing technologies (P = 0.003), whereas Breslow thickness and operation time per harvested SN decreased (P = 0.003 and P = 0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time, and complication rate between the different groups. Conclusion: The use of advanced detection technologies led to a higher number of identified SNs without an increase in overall operation time, possibly indicating an improved surgical efficiency. Operation time per harvested SN decreased; the average FN rate remained 11.9% and was unchanged over 23 y. There was no significant change in postoperative complication rate.

Non-radical primary diagnostic biopsies affect survival in cutaneous head and neck melanoma

Background It is unclear if a non-radical diagnostic biopsy entails a higher risk for metastasis and poorer survival for patients with cutaneous head and neck melanoma (cHNM). Aims/objectives To assess whether or not initial diagnostic biopsy modality and radicality (clear, positive, or narrow histopathological margins) influence recurrence and survival in patients with cHNM. Materials and methods Histopathological radicality of initial diagnostic biopsies and outcome for 368 consecutive cHNM patients, clinically asymptomatic of metastatic disease and referred to a tertiary care academic center for sentinel lymph node staging from 2004 through 2018, were retrospectively analyzed. Results Patients with positive (n = 133) or narrow (0.1–0.5 mm) (n = 34) histopathological margins had significantly worse loco-regional (p=.004) and distant control (p=.004) as well as lower overall (p=.017) and melanoma specific (p=.0002) survival than 201 patients with clear margins. Multivariate analysis indicated positive or narrow histopathological margins as independent negative prognostic factors for melanoma specific survival (HR 2.16, p=.015), together with deeper Breslow (HR 1.17, p=.00001) and ulceration (HR 2.49, p=.003). Conclusions and significance Non-radical primary diagnostic biopsies increase the risk for metastatic disease and impair survival in cHNM. Accordingly, radical melanoma diagnostic procedures should be encouraged in the head and neck region when possible.

Post-operative follow-up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia.

Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post-operative follow-up of 150 patients. We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post-operative complications and patients' satisfaction after SLNB under TLA. 32% of the patients reported post-operative pain within the first 48h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3% of the patients. 98.7% of the patients were satisfied with SLNB under TLA. SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.

Sentinel lymph node biopsy in head and neck cutaneous melanomas: A PRISMA-compliant systematic review and meta-analysis.

Background:Head and neck melanomas (HNMs) behave differently from cutaneous melanomas in other sites, and the efficacy of sentinel lymph node biopsy (SLNB) for patients with HNMs remains controversial.Methods:Studies on prognosis following SLNB were included. The prognostic role of SLNB and other potential predictors were analyzed using pooled relative risk (RR) or hazard ratio (HR).Results:Pooled statistics showed that SLNB improved overall survival of HNMs patients (HR = 0.845; 95% CI: 0.725–0.986; P = .032). The positive status of SN was proved as a risk factor of poor prognosis in HNMs (HR = 3.416; 95% CI: 1.939–6.021; P < .001). SLNB did not have significant correlation with lower recurrences (RR = .794; 95% CI: 0.607–1.038; P = .091).Conclusions:SLNB is associated with better overall survival and the SN status is a promising risk factor of poor prognosis for HNMs patients.

Sentinel node procedure of head and neck melanomas; a successful surgical procedure with low morbidity.

Background: The value of the sentinel node (SN) procedure of head and neck melanomas has been doubted by many experts. Due to the lack of consensus the procedure has not consistently been offered. However, in November 2018 the Dutch government approved adjuvant therapy for patients with proven nodal metastases, causing a significant change in the procedure’s value. The goal of this study was to investigate the success rate and morbidity of this procedure. Additionally, it tested if potential tumor- or patient characteristics have a significant impact on these outcomes.

Limb melanomas: acral melanomas have worse survival

Background The anatomic site of primary melanoma is significantly correlated with survival, and extremity melanomas have better prognosis than trunk or head and neck melanomas. Aim The aim of this study was to review and evaluate the prognostic factors and survival outcomes associated with both upper and lower extremity melanomas. Methods A total of 524 limb-located melanomas were analyzed retrospectively. Results Lower extremity melanomas were predominant in number and feet/toes melanomas were more frequently found in the elderly. Acral lentiginous melanomas were found to affect more frequently lower limbs and showed mainly distal distributions for both limbs. However, acral melanomas were more often ulcerated and they were more frequently BRAF wild-type melanomas associated with significant lymphovascular invasion. Foot and toe melanomas relapsed more frequently than leg melanomas. The 5-year overall survival rates for upper and lower limbs were the same, 62%. The finger (p = .0001) and toe (p = .005) melanomas had worse overall survivals than arm and leg melanomas, respectively. Both overall and disease-free survivals of acral melanoma patients were found worse than those of nonacral melanoma patients, p = .0001 and p = .001 respectively. Despite not having adjusted by Breslow, ulceration and nodal involvement status, acral location per se could be associated with poorer outcome in our retrospective study. Conclusion Even though they were not found to be correlated with major predictors of poor prognosis, acral melanomas significantly predict poor survival.

A 10 year retrospective analysis of primary head and neck melanoma

A 10 year retrospective analysis of primary head and neck melanoma

Can we reduce wide local excision margins for head and neck melanoma: a 10 year retrospective analysis of head and neck cutaneous melanoma

Introduction: Although wide local excision is the standard treatment for primary melanomas, the surgical margin remains controversial. Melanomas of the head and neck exhibit higher recurrence rates and worse prognosis than lesions in other body locations and they are in close proximity to critical anatomical and functional structures where wide margins of excision are often not feasible. Surgeons must achieve a balance of oncological safety and functional and aesthetic needs.

Head and neck cutaneous melanoma: 5-year survival analysis in a Serbian university center

BackgroundHead and neck melanoma (HNM) is specific from the anatomical and etiopathogenetic aspects. In addition to morphopathological parameters, rich vascularization and lymphatic drainage of the head and neck affect the occurrence of lymphogenic and hematogenous metastases, as well as the metastases on both sides of the neck.MethodsA retrospective cross-sectional study included cutaneous melanoma patients who underwent surgery at a clinical center over a 10-year period. The clinical follow-up was at least 60 months. The Kaplan-Meier method was used for the survival analysis. The predictor effect of certain independent variables on a given dichotomous dependent variable (survival) was measured by the Cox regression analysis.ResultsThe analysis of demographic and clinical characteristics of 116 patients with HNM revealed that there was no statistically significant difference in age and gender in the total sample. Thirty-three (28.45%) patients were already in stage III or IV of the disease at the first examination, which affected the overall survival rate. The overall 5-year survival was 30.2%. No statistically significant difference in 5-year survival was found in relation to age and location. The period without melanoma progression decreased progressively in the advanced stage. Forty-nine patients (42%) underwent surgery for lymphogenic metastases in the parotid region and/or neck during the follow-up.ConclusionsPatients with HNM included in this study frequently presented an advanced stage of the disease at the first examination, which is reflected in a low rate of 5-year survival. Early diagnosis and adequate primary treatment can ensure longer survival.

Can we reduce excision margins for head and neck melanoma? A 12-year retrospective study

Although wide local excision is the standard treatment for primary melanoma, the surgical margin remains controversial. Melanomas of the head and neck exhibit higher recurrence rates and worse prognosis than lesions in other body locations, and their close proximity to critical anatomical and functional structures means that wide excision margins are often not feasible. Surgeons must therefore achieve a balance of oncological safety and functional and aesthetic needs. The aim of this study was to retrospectively analyse melanoma data over a 12-year period at a large skin surgery unit to identify potential differences in outcomes in patients who had reduced wide local excision margins for primary head and neck melanoma. The study would provide further evidence for the need for large randomised prospective trials to reduce excision margins for head and neck melanoma. Local cancer network data were retrospectively analysed over a period of 12 years (2008-2019). Data included site, initial stage, multidisciplinary team (MDT) meeting recommendations for excision margins and the actual wide local excision margin taken, recurrence rate, and disease-specific and absolute survival. A total of 222/305 patients (73%) had the recommended excision margin, while in 27% margins were reduced due to anatomical or functional considerations. Recurrence rates were similar (recommended 11.7% vs narrow 13.3% excision margins) (p = 0.64). The mean follow-up time for all patients was 48.5 months. In aesthetically and functionally sensitive areas of the head and neck, wide local excision margins need to be carefully considered after MDT discussion and discussion with the patient. This study suggests the need for further multicentre trials to address the uniqueness of head and neck melanoma.

Outcomes and predictors of survival in cutaneous melanoma of the eyelid: An analysis of the National Cancer Database

To the Editor: Eyelid melanoma (EM) is a rare condition that accounts for <1% of eyelid malignancies.1 EM is traditionally believed to behave similarly to cutaneous melanoma (CM) elsewhere in the head and neck (HN).2 However, the eyelid is unique in its anatomic features and lymphatic drainage, which may cause lesions of the eyelid and to behave differently than other HN CM cases.2 This study investigated the demographics, survival, and prognostic factors of EM in situ and invasive EM in the National Cancer Database and compared invasive EM against other (noneyelid) invasive head and neck (OIHN) melanoma of the skin.

Association of Known Melanoma Risk Factors with Primary Melanoma of the Scalp and Neck

Scalp and neck (SN) melanoma confers a worse prognosis than melanoma of other sites but little is known about its determinants. We aimed to identify associations between SN melanoma and known risk genes, phenotypic traits, and sun exposure patterns. Participants were cases from the Western Australian Melanoma Health Study (n = 1,200) and the Genes, Environment, and Melanoma Study (n = 3,280). Associations between risk factors and SN melanoma, compared with truncal and arm/leg melanoma, were investigated using binomial logistic regression. Facial melanoma was also compared with the trunk and extremities, to evaluate whether associations were subregion specific, or reflective of the whole head/neck region. Compared with other sites, increased odds of SN and facial melanoma were observed in older individuals [SN: OR = 1.28, 95% confidence interval (CI) = 0.92-1.80, P trend = 0.016; Face: OR = 4.57, 95% CI = 3.34-6.35, P trend < 0.001] and those carrying IRF4-rs12203592*T (SN: OR = 1.35, 95% CI = 1.12-1.63, P trend = 0.002; Face: OR = 1.29, 95% CI = 1.10-1.50, P trend = 0.001). Decreased odds were observed for females (SN: OR = 0.49, 95% CI = 0.37-0.64, P < 0.001; Face: OR = 0.66, 95% CI = 0.53-0.82, P < 0.001) and the presence of nevi (SN: OR = 0.66, 95% CI = 0.49-0.89, P = 0.006; Face: OR = 0.65, 95% CI = 0.52-0.83, P < 0.001). Differences observed between SN melanoma and other sites were also observed for facial melanoma. Factors previously associated with the broader head and neck region, notably older age, may be driven by the facial subregion. A novel finding was the association of IRF4-rs12203592 with both SN and facial melanoma. Understanding the epidemiology of site-specific melanoma will enable tailored strategies for risk factor reduction and site-specific screening campaigns.

Melanomas of the scalp: is hair coverage preventing early diagnosis?

Scalp melanomas are usually thicker and show worse prognosis than other sites and other head and neck melanomas. One hypothesis to explain this aggressive behavior could be diagnosis delay attributed to hair concealment of lesions. Primary melanomas of the scalp diagnosed over two decades at four reference centers in Australia and Italy were included. Hair coverage and visibility of the lesions were assessed on preoperative photographic documentation by two investigators and correlated with some prognostic factors (Breslow thickness, mitotic rate, and ulceration). Patients records and pathology reports provided clinical and histological data. The majority of 113 melanomas included were located on easily visible areas of the scalp - hairless scalp (49%) or hairline (15%). The remaining ones (36%), considered to be hair-covered, showed more frequently thinning of hair (63%) than a dense hair coverage (37%). Melanomas of "hairy scalps" were more frequently invasive (81%) and had higher median Breslow (0.8±1.3mm) than those arising on bald scalps or areas with thinning of hair (43%; 0±0.6mm), P=0.004. However, when considering only the invasive cases (n=55), Breslow thickness and mitotic rate were not statistically different between concealed and easily visible areas. Melanomas detected by a doctor were thinner than those first noticed by the patient, relatives, or a hairdresser (P<0.001). Most scalp melanomas arose on easily visible areas, which are more prone to ultraviolet damage. Hair-covered ones, despite rare, could be overlooked during examination. Proactive screening of the scalp area should be encouraged.

Primary cutaneous melanoma of the scalp: Patterns of clinical, histological and epidemiological characteristics in Brazil.

Scalp melanoma is a subgroup of melanomas on the head and neck, historically associated with worst prognosis. Knowledge of the usual presentation of scalp melanoma can help to understand the reasons for the poor outcomes of treatment. This is the first publication to describe the clinical, histopathological and epidemiological profile of patients with scalp melanoma in a Latin American population. A cross-sectional study was performed of all primary cutaneous melanoma seen by the A.C.Camargo Cancer Center between 2008 and 2018, using an electronic health records to access clinical and pathology data. When compared to trunk and limbs, increasing age is expected for patients with scalp melanoma (10.865; CI (95%) = [8.303; 13.427]). Regarding risk of invasion, scalp melanomas have a higher chance to be invasive than in situ (OR = 1.783; CI (95%) = [1.196; 2.657]) and present with higher Breslow thickness (OR = 3.005; CI (95%) = [2.507; 3.601]). Scalp site was significantly associated with male sex (OR = 3.750; CI (95%) = [2.533; 5.554]), perineural invasion (OR = 13.739; CI (95%) = [5.919; 31.895]), ulceration (OR = 2.311; CI (95%) = [1.488; 3.588]), and mitosis (OR = 2.366; CI (95%) = [1.701; 3.292]), when compared to trunk and limbs melanoma. In the present study, head and neck melanomas represented 14.9% of all melanomas, a frequency slightly lower than that described in the literature and the mean age of melanoma on the scalp found was lower than that reported in the literature. These results could be explained by the demographic characteristics of Brazil, which has a population with a lower life expectancy compared to the European and North American population. Scalp melanomas occurred in older men, were diagnosed with greater Breslow thickness and were associated with the presence of perineural invasion, mitosis and ulceration.

Abstract A01: Clinical detection of melanoma via endogenous fluorophore lifetime imaging

Abstract Objective: The 5-year survival for cutaneous malignant head and neck melanoma is very poor (17%). As proof of principle, we detect variations in endogenous fluorophore lifetimes by illuminating tissue with pulsed ultraviolet (UV) light. We have previously shown that dynamic optical contrast imaging is capable of delineating tumor margins. Our aim herein was to acquire clinical and intraoperative multispectral images that permit selection of regions of interest (ROI) to reliably and noninvasively perform a rapid optical biopsy in the patient. Methods: Patient cases of cutaneous melanoma were acquired with pulsed UV illumination utilizing a 6-diode in-series system. Emitted fluorescence was detected with a nanosecond gated CCD detector. The acquired signal is transformed into a relative difference value representing tissue fluorophore lifetime. Results: From (n=4) patient cases we acquired DOCI images both pre- and post-resection leading to a database of in vivo relative lifetime values that align to histology sections from corresponding locations via pathology. The spectral features of our images enabled classification of clinician-determined regions of interest in DOCI images in order to establish measures of internal and external validity of our novel device. Conclusion: Our device augments native tissue contrast via wide-field imaging to produce spatially resolved and pathology-specific maps of tissue. Our database of histology-matched real-time images is aimed to permit intraoperative guidance for tumor margin delineation in dermatologic surgery. Citation Format: Peter A. Pellionisz, Yong Hu, Jenny Kim, Warren Grundfest, Maie A. St. John. Clinical detection of melanoma via endogenous fluorophore lifetime imaging [abstract]. In: Proceedings of the AACR Special Conference on Melanoma: From Biology to Target; 2019 Jan 15-18; Houston, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(19 Suppl):Abstract nr A01.

Abstract 4509: Targeting tumor-derived exosomes using a lectin affinity hemofiltration device

Abstract Background: Tumor-derived exosomes (TEX) are 30-150 nm vesicles that are released by tumor cells and have systemic disease-promoting effects. Despite abundant research showing that TEX are purveyors of tumor growth-promoting and immunosuppressive cargo, a clinical strategy for addressing exosomes in oncology is lacking. Aethlon Medical is initiating clinical trials in cancer patients with the Hemopurifier®, a hollow fiber hemofiltration device that is operated using dialysis infrastructure, for removing exosomes from circulating blood. The Hemopurifier incorporates size exclusion and a lectin (Galanthus nivalis agglutinin; GNA) affinity matrix for capturing nanoparticles having high mannose glycoprotein surface structures. Experimental Procedures: A benchtop version of the Hemopurifier was operated by recirculating samples of cancer patients' plasma through the hollow fiber filters ex vivo. The exosomes remaining in plasma were quantified using nanoparticle tracking analysis measurements and the ExoView instrument. To identify the Hemopurifier-bound material, an elution technique was developed to displace the GNA-bound material from the Hemopurifier. The recovered vesicles were assessed using ExoView and flow cytometry and compared to an established exosome isolation method, size exclusion chromatography, which utilizes small-size ion exchange columns (mini-SEC). In vitro assays were also performed by co-culturing the recovered exosomes with T cells to evaluate their immunosuppressive functions. Results: The results demonstrate that the GNA affinity capture mechanism of the Hemopurifier is effective for clearing 92-99% of exosomes from input concentrations of 109-1010 exosomes per mL of plasma. The device captures exosomes from diverse tumor types including head and neck cancer, melanoma, ovarian cancer, esophageal cancer and breast cancer. Analysis of plasma samples from Stages III and IV triple negative and human epidermal growth factor receptor 2 overexpressing breast cancer showed that Hemopurifier-bound material comprised the appropriately-sized vesicles expressing tumor susceptibility gene 101 and tetraspanins. In comparison to mini-SEC-isolated exosomes, tumor-specific epitopes and immunosuppressive proteins exhibited equivalent expression among Hemopurifier-isolated exosomes. The immunosuppressive functions of Hemopurifier- and mini-SEC-isolated exosomes were also equivalent. Conclusions: The Hemopurifier effectively clears exosomes present in plasma that originate from diverse types of cancer. The Hemopurifier-captured exosomes exhibit signatures of malignancy and immunosuppression and are therefore relevant therapeutic targets. This research was supported by the National Cancer Institute of the National Institutes of Health under award number 1R43CA232977-01. Citation Format: Annette M. Marleau, Michael T. Jacobs, Nadia Gruber, Timothy C. Rodell, Soldano Ferrone, Theresa L. Whiteside. Targeting tumor-derived exosomes using a lectin affinity hemofiltration device [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4509.

Completion lymph node dissection in patients with sentinel lymph node positive cutaneous head and neck melanoma.

Relatively few cutaneous head and neck melanoma (CHNM) patients with were included in the multicenter selective lymphadenectomy trial II (MSLT-II). Our objective was to investigate whether immediate completion lymph node dissection completion of lymph node dissection (CLND) was associated with survival benefit for sentinel lymph node (SLN) positive CHNM using the National Cancer Database. SLN positive patients with CHNM from 2012 to 2014 were retrospectively analyzed. Patients were divided into two groups: those who underwent SLN biopsy (SLNB) only versus those who underwent SLNB followed by CLND (SLNB + CLND). The primary outcome was 5-year overall survival (OS). Among 530 SLNB + patients, 342 patients underwent SLNB followed by CLND (SLNB + CLND). The SLNB only group had fewer positive SLN, less advanced pathologic stage, and a lower rate of adjuvant immunotherapy. There was no significant difference in 5-year OS between the two groups (51.0% vs 67%; P = .56). After adjusting for pathologic stage, there remained no difference in 5-year OS among patients with stage IIIA (63.0% vs. 73.6%, P = 0.22) or IIIB/IIIC disease (39.1% vs 57.8%; P = .52). Conclusions Using a large nationwide database, CLND was not shown to be associated with improved OS for patients with SLNB positive CHNM, validating the results of MSLT-II.

Cutaneous Head and Neck Melanoma: Changes in Clinical and Histologic Features From 1995 to 2015 in a Tertiary Hospital in Madrid, Spain

Background and objectiveFew epidemiological studies have analyzed cutaneous head and neck melanoma (CHNM) in the Spanish population. The aim of this study was to describe the clinical and histologic features of a representative sample of CHNM in Spain and to analyze changes observed over a period of 21 years. Material and methodsDescriptive, retrospective, cross-sectional study of 280 patients diagnosed with CHNM at Hospital General Universitario Gregorio Marañón in Madrid, Spain, between January 1, 1995, and December 31, 2015. The main clinical and histologic features were analyzed and compared between 3 periods: 1995–2001, 2002–2008, and 2009–2015. ResultsMean age at diagnosis was 71.3 years (median, 74 years; interquartile range [IQR], 65–81 years). The most common location was the face, followed by the scalp. The main histologic subtype was lentigo maligna (n=172, 64%). Mean tumor thickness was 1.6mm (median, 0.4mm; IQR, 0–2.1mm). Median follow-up was 111 months; in this time 51 patients experienced CHNM recurrence (18.2%) and 29 died of the disease (10.4%).In the years analyzed, we observed a significant increase in the number and percentage of patients aged 75 years or older (P=.001) and in the percentage of melanomas in situ (P=.003). We also observed a significant decrease in mean tumor thickness (P=.018), the number of cases with 6 or more mitotic figures (P=.013), the percentage of patients with metastasis (P=.014), and melanoma-specific mortality (P=.005). ConclusionsCHNM affects elderly patients and is preferentially located on the face. The predominant subtype is lentigo maligna. Patients presented with thinner tumors over time and are now less likely to develop metastasis and to die of melanoma.

Recent developments in head and neck melanoma.

To provide an overview of recently published articles covering melanoma management of the head and neck region. Melanoma management represents a rapidly evolving field. The advent of immunotherapy has led to significant changes in diagnosis, treatment, and surveillance for these patients. Invasive interventions including completion lymph node dissection have been largely replaced with increased surveillance driven by robust data showing no significant difference in overall survival. Studies have explored various treatment regimens that offer improved outcomes with the least adverse events, with a recent trend towards neoadjuvant therapy. Research has also shifted towards better understanding genetics and biomarkers that influence response to these medications. The best means to both identify and monitor these changes is being explored. As our understanding of this complex disease process continues to grow, prognosis in patients suffering with melanoma should continue to improve. The expansion of immunotherapy use in melanoma management has led to significantly improved prognosis in diagnosed patients. Present research is largely focused on better understanding the ideal patient populations, dosing, and surveillance for these therapies. Data from these studies will be crucial in better staging and treating patients with melanoma.

Melanoma cutáneo de cabeza y cuello: evolución de las características clínico-patológicas en un hospital terciario de Madrid (1995-2015)

ObjectivesFew epidemiological studies have analyzed cutaneous head and neck melanoma (CHNM) in the Spanish population. The aim of this study was to describe the clinical and histologic features of a representative sample of CHNM in Spain and to analyze changes observed over a period of 21 years. Material and methodsDescriptive, retrospective, cross-sectional study of 280 patients diagnosed with CHNM at Hospital General Universitario Gregorio Marañón in Madrid, Spain, between January 1, 1995, and December 31, 2015. The main clinical and histologic features were analyzed and compared between 3 periods: 1995-2001, 2002-2008, and 2009-2015. ResultsMean age at diagnosis was 71.3 years (median, 74 years; interquartile range [IQR], 65-81 years). The most common location was the face, followed by the scalp. The main histologic subtype was lentigo maligna (n=172, 64%). Mean tumor thickness was 1.6 mm (median, 0.4mm; IQR, 0-2.1mm). Median follow-up was 111 months; in this time 51 patients experienced CHNM recurrence (18.2%) and 29 died of the disease (10.4%).In the years analyzed, we observed a significant increase in the number and percentage of patients aged 75 years or older (P=.001) and in the percentage of melanomas in situ (P=.003). We also observed a significant decrease in mean tumor thickness (P=.018), the number of cases with 6 or more mitotic figures (P=.013), the percentage of patients with metastasis (P=.014), and melanoma-specific mortality (P=.005). ConclusionsCHNM affects elderly patients and is preferentially located on the face. The predominant subtype is lentigo maligna. Patients presented with thinner tumors over time and are now less likely to develop metastasis and to die of melanoma.