Scalp Melanoma Research Articles

Clinical and histologic signs of regression two months after initiation of treatment with dabrafenib and trametinib in a case of stage IIIc BRAF V600E-positive scalp melanoma

Clinical and histologic signs of regression two months after initiation of treatment with dabrafenib and trametinib in a case of stage IIIc BRAF V600E-positive scalp melanoma

Scalp Melanoma Diagnosed by Fine Needle Aspiration Cytology in a Tertiary Health Center.

Melanoma is one of the most aggressive malignant skin neoplasms worldwide with more than 20% of world melanoma seen in black Africa and Asia. Late presentation due to ignorance, poverty, and lack of adequate health facility in Nigeria is always the norms. We present this case report because of precision in diagnosis, using fine needle aspiration cytology (FNAC) to reemphasize that the technique is cheap, cost effective, and quick that can reduce the burden of incisional biopsy before definitive surgery and improve early detection of the disease especially in developing countries.

Scalp Melanoma and In-transit Metastases: A Retrospective Case-controlled Study

Scalp Melanoma and In-transit Metastases: A Retrospective Case-controlled Study

Primary melanoma location on the scalp is an important risk factor for brain metastasis: a study of 1,687 patients with cutaneous head and neck melanomas.

Primary cutaneous head and neck melanomas (HNM) are reported to be associated with a higher incidence of brain metastasis than trunk and limb melanomas (TLM). In this study, the incidence of brain metastases in patients with HNM and risk factors for the development of brain metastases were analyzed. From a large, prospectively-collected database, 1,687 HNM patients and 8,793 TLM patients who presented with American Joint Committee on Cancer (AJCC) stage I and II disease were identified. Survival was assessed using the Kaplan-Meier method and multivariate Cox regression analysis. Independent risk factors were determined by binary logistic regression analysis. The incidence of brain metastases 5years after diagnosis of HNM was 6.7% compared with 4.7% for brain metastases from TLM (p=0.003). Patients with scalp melanomas were most likely to develop brain metastases (12.7%). Independent risk factors for brain metastasis in patients with HNM were Breslow thickness, ulceration, and scalp location. Patients with primary scalp melanomas had a much higher incidence of brain metastasis than patients with melanomas on other head and neck sites, who in turn had a higher incidence than patients with melanomas on sites elsewhere on the body. More intensive monitoring of patients with scalp melanomas, who are at particularly high risk of brain metastasis, might lead to earlier discovery of metastatic disease in the brain, offering the prospect of earlier intervention and better outcomes.

Long-term Survival after Metastatic Childhood Melanoma

Summary:Malignant melanoma in children is very rare and accounts for only 1–3% of all melanomas. A congenital melanocytic nevus depending on the size of the lesion is one of the risk factors for developing childhood melanoma because of the possible malignant transformation. Childhood malignant melanoma is a potentially fatal disease. Surgical excision is the primary treatment of choice for malignant melanoma. Clinicians need to be aware of the possible malignant transformation in children with congenital melanocytic nevus because early diagnosis and treatment improves prognosis. The suspicion of malign melanoma must be in mind when evaluating a pigmented lesion in a pediatric patient. We present a case of a patient born with a congenital nevus diagnosed with metastatic childhood malignant scalp melanoma at the age of 6 years. The patient underwent surgical ablation and reconstruction and has survived 26 years without recurrence, thus representing an uplifting case of long-term survival of childhood melanoma.

Patterns of failure and predictors of outcome in cutaneous malignant melanoma of the scalp

Patients with melanoma of the scalp may have higher failure (recurrence) rates than melanoma of other body sites. We sought to characterize survival and patterns of failure for patients with scalp melanoma. Between 1998 and 2010, 250 nonmetastatic patients underwent wide local excision of a primary scalp melanoma. Kaplan-Meier analyses were performed to evaluate overall survival, scalp control, regional neck control, distant metastases-free survival, and disease-free survival. Five-year overall survival was 86%, 57%, and 45% for stages I, II, and III, respectively, and 5-year scalp control rates were 92%, 75%, and 63%, respectively. Five-year distant metastases-free survival for these stages were 92%, 65%, and 45%, respectively. Of the 74 patients who recurred, the site of first recurrence included distant disease in 47%, although 31% recurred in the scalp alone. This is a retrospective review. Distant metastases-free survival and overall survival for stage II and III patients with scalp melanoma are poor, and stage III patients experience relatively high rates of scalp failure suggesting that these patients may benefit from additional adjuvant systemic and local therapy. Further research is needed to characterize the environmental, microenvironmental, and genetic causes of the increased aggressiveness of scalp melanoma and to identify more effective treatment and surveillance methods.

Accuracy and prognostic value of sentinel lymph node biopsy in head and neck melanomas

BackgroundDebate remains around the accuracy and prognostic implications of sentinel lymph node biopsy (SLNB) for melanoma arising in the head and neck (HN) areas because several analyses have shown discordances between clinically predicted lymphatic drainage pathways and those identified by lymphoscintigraphy. This study assesses the accuracy and prognostic value of SLNB in this critical anatomic region. MethodsRetrospective review of a prospectively collected melanoma database identified 331 patients with HN melanomas from January 2000 to December 2012. Primary end points included SLNB result, time to recurrence, site of recurrence, and survival. Multivariate models were constructed for analyses. ResultsA sentinel lymph node (SLN) was identified in all 331 patients. There were 59 patients with a positive SLN (17.8%) with a recurrence rate of 88.1% compared with 22.4% in SLN-negative patients (P < 0.0001). The 5-y overall survival was 91.2% for SLN-negative patients and 48.7% for SLN-positive patients (P < 0.0001). Patients with scalp melanoma had thicker lesions and an elevated risk of SLN positivity, recurrence, and death compared with those with other sites. Among the 272 SLN-negative patients, four patients developed regional nodal disease in the same basin and had undergone a previous SLNB procedure for a false-omission rate of 1.45%. Risks for false-negative SLN occurrences included thick and scalp melanomas. Multivariate analysis on prognostic factors affecting relapse-free survival showed positive SLNB status to be the most prognostic clinicopathologic predictor of recurrence (hazard ratio, 20.56; P < 0.0001). ConclusionsSLNB for patients with HN melanomas is an accurate procedure and has prognostic value.

Comparison of mucosal and cutaneous melanoma in the head and neck region: Different clinical features and similar outcomes.

e20016 Background: Mucosal melanoma (MM) of head and neck (H&amp;N) is a relatively rare and different disease from cutaneous melanoma (CM). We aimed to define clinical features and outcomes of patients with MM of H&amp;N and to emphasize its differences from CM. Methods: The medical records of patients (n= 41 for MM, n=94 for CM) between 2000 and 2010 were assesed. Results: In MM group, 21 patients had primary oral cavity (OCM) and 20 had sinonasal melanoma (SNM). The median age was 60 years and gender distribution was similar. Thirty-two (78%) of patients had stage I, 4 (10%) had stage II, and 5 (12%) patients had stage III disease. One and 5-year overall survival (OS) rates were 81% and 58%, and similar for SNM and OCM (p=0.67). Among CM patients, primary sites were face (53%), scalp (28%) and ear region (19%). Facial melanoma (FM) patients were older (p=0.001) than scalp (SM) or ear melanoma (EM). Male gender was more frequent among SM patients (81%) than FM (42%, p=0.001) and EM (50%, p=0.03). Most of FM patients had localized disease (84%), while most of EM (72%) and SM (46%) patients had advanced disease. One and 5-year OS rates of CM were 86% and 43%, respectively. Five-year OS rates were 72% for FM, 27% for EM and 17% for SM (FM v SM, p&lt;0.001; FM v EM, p=0,012; EM v SM, p=0.40). Advanced disease (stage III and IV) had significant impact on OS (p=0.001) for only SM patients. In addition, male patients with CM had poorer prognosis than female patients (p=0.034). However, age of patient did not affect OS. MM group was older (median 60 v 54 years, p= 0.008) and had a higher rate of localized disease than CM (78% v 65%, p=0.06). Advanced disease had a significant impact on OS for both MM and CM (p= 0.03). OS rates of CM and MM were similar (p=0.53). Conclusions: Melanoma of H&amp;N region is a very heterogeneous disease. MM has different clinicopathologic features from CM. Primary site of melanoma in this region is also important for prognosis and biological behaviour of tumour. Therefore, approaches to these melanomas should be different.

Sentinel lymph node status is the most important prognostic factor in patients with melanoma of the scalp

To compare clinicopathologic and prognostic factors associated with scalp melanomas and nonscalp melanomas of the head and neck (H&N). Post hoc analysis of the database from a multi-institutional, prospective, randomized study. Clinicopathologic factors were assessed and correlated with survival and recurrence. Univariate and multivariate analysis of prognostic factors affecting disease-free survival and overall survival were performed. Of 405 patients with H&N melanomas ≥1.0 mm Breslow thickness, 109 patients had melanoma of the scalp. All were Caucasian (100%), with most being male (79.5%) with a mean age of 49.8 years. The mean Breslow thickness was 2.4 mm; 25% had signs of ulceration. Sentinel lymph node (SLN) positivity was seen in 20.9% of scalp melanoma patients, and was more likely in younger patients (44.7 vs. 50.8 years, P = .04) and in those with a Breslow thickness of 2 to 4 mm (P = .005). The incidence of locoregional and distant recurrence were similar. Overall survival for scalp melanoma patients was significantly impacted by SLN positivity (P = .03), whereas Breslow thickness and ulceration status predicted poorer survival in nonscalp melanoma patients (P = .005, P < .0001, respectively). In the Sunbelt Melanoma Trial, SLN status was the strongest predictor of overall survival in scalp melanoma. Tumor thickness and ulceration correlated with poorer overall survival in nonscalp H&N melanoma. The prognostic significance of SLN status in the H&N may vary with the melanoma site.

The prognostic impact of the anatomical sites in the ‘head and neck melanoma’

Cutaneous melanoma is a malignant neoplasia with several demographic and histopathological prognostic factors. Many studies stress that the head and neck region has a worse prognosis compared with other localizations, but the reasons for this worse prognosis are unclear. Therefore, the aim of our study is to analyse the poor prognosis of head and neck melanoma (HNM) with respect to the other anatomical sites, considering the face and neck (F&N) and the scalp separately. We carried out a retrospective analysis of 757 melanoma patients. In particular, we studied the prognostic impact of different melanoma skin localizations (head and neck, trunk, upper extremities and lower extremities). Afterwards, we divided HNM into two subgroups, F&N and scalp, to evaluate their impact in the HNM prognosis. Data showed a significantly lower 5-year overall survival probability for HNM (78.9 versus 93.1% for other body sites; P=0.05). Moreover, on analysing the two anatomical areas considered among HNM, we observed a 5-year overall survival of 81.8% for F&N and 66.7% for scalp. HNM has different and worse prognostic features with respect to other sites, but this trend is not only because of scalp melanoma but is also determined by F&N melanoma, which we believe to be underestimated until now.

The Role of Full-Thickness Scalp Resection for Management of Primary Scalp Melanoma

Scalp melanoma is aggressive and has a proclivity for regional metastasis. We hypothesize that subperiosteal scalp melanoma resection reduces in-transit/satellite recurrence, when compared with subgaleal resection. We identified patients with intermediate to deep, primary scalp melanoma referred to head/neck surgery over an 8-year period. Patients were compared based on scalp resection depth, including subperiosteal (resection to the level of calvarium) and subgaleal (resection including skin, subcutaneous tissue, and galea). The dependent variables were in-transit/satellite recurrence and time to in-transit/satellite recurrence. Among 48 identified patients, the in-transit/satellite recurrence rate was 16.7%. Subgaleal resection patients had higher in-transit/satellite recurrence rates than subperiosteal resection patients (24.0% vs. 8.7%, P=0.155). Among node-negative patients, subgaleal resection had significantly higher in-transit/satellite metastasis rates when compared with subperiosteal resection (26.3% vs. 0%, P=0.047). For node-negative, primary scalp melanoma, subperiosteal resection significantly decreases in-transit/satellite recurrence when compared with subgaleal resection. Given our small sample size, further studies are necessary to confirm these results.

Long‐Term Prognosis and Significance of the Sentinel Lymph Node in Head and Neck Melanoma

To report the long-term significance of sentinel lymph node (SLN) biopsy on prognosis, determine false-negative SLN occurrences, and determine risk factors for death and recurrence in a large series of patients with head and neck melanoma. Case series with tumor registry review. Academic tertiary care medical center. A database review was performed of all patients who underwent SLN biopsy for head and neck melanoma from 1994 to 2009. End points assessed were SLN status, recurrence, false-negative SLN results, and survival comparing SLN-positive and SLN-negative patients and different locations. Survival curves and multivariate analyses were performed. SLN biopsy was performed in 365 patients. SLNs were identified in 98.6% of patients with a mean of 3.7 nodes removed from 1.6 nodal basins per patient. Median follow-up was 8 years. The SLN was positive in 40 (11%) patients. SLN-positive patients had significantly thicker melanomas, higher recurrence (P < .0001), and a significant decrease in overall survival compared with SLN-negative patients (P < .002). Scalp melanoma patients had significantly thicker melanomas and an elevated risk of SLN positivity, recurrence, and death compared with other sites. Seventeen of 365 SLN-negative patients developed regional nodal disease for a false-omission rate of 5.2% and a negative predictive value of a negative SLN to be 94.8%. Risks for false negative-SLN occurrences included thick melanomas and scalp melanomas. SLN biopsy is accurate in head and neck melanoma and provides significant prognostic data. Scalp melanoma patients present with thicker tumors with an increase in SLN positivity and false-negative SLN occurrences.

Review of Patients with Cutaneous Melanoma of the Scalp Treated with Local Excision with or without Radiation Therapy

Patients with scalp/neck melanomas have been shown to have a worse prognosis compared to other cutaneous melanomas. The factors responsible for this are not well established. We reviewed our experience with scalp melanoma to better characterize patterns of failure and factors predictive of relapse.

Dermoscopy of Scalp Melanoma: Report of Three Cases

Scalp melanoma is rare and often late-discovered because of its unusual position. As a consequence, its prognosis is poorer than melanoma on other body sites and only few clinical reports about its dermoscopic pattern have been published. In this paper, we report three clinical cases of scalp melanoma with photographic documentation and dermoscopic images, in order to improve the early detection of scalp melanoma.

Massive bleeding of ruptured metastatic hepatic melanoma treated by transarterial embolization

Although melanoma frequently metastasizes to the liver, its spontaneous rupture is rare. We report herein an unusual case of a 73-year-old man with rupture of multiple hepatic metastases from scalp melanoma and resulting massive intraperitoneal bleeding, which was successfully controlled by transarterial embolization.

Profiling and Discovery of Novel miRNAs from Formalin-Fixed, Paraffin-Embedded Melanoma and Nodal Specimens

Archived formalin-fixed, paraffin-embedded human tumors are widely available and represent a unique source of morphologically defined material. Formalin-fixed, paraffin-embedded tissue is known to contain a wealth of molecular information in the form of microRNAs (miRNAs), which could be correlated with clinical outcome for improved prognostication and/or treatment response. miRNAs are endogenous, noncoding RNAs ( approximately 22 nucleotides) and may function as tumor suppressors or oncogenes. A reliable, robust methodology is needed to take full advantage of archived human cancers, especially for those where fresh-frozen tumor banks are unavailable, for example, malignant melanoma. To this end, we applied a simple-to-use protocol for extracting total RNA from various formalin-fixed, paraffin-embedded specimens (colon, liver, prostate, thyroid, uterus, and skin), optimized for small RNA recovery. Using a "poison primer" strategy (ie, primer silencing), we blocked the amplification of ribosomal RNA, enabling the successful sequencing of 17 novel and 53 known miRNAs (including small RNAs) from 10-year-old archived normal skin, cutaneous scalp melanoma, and sentinel lymph nodes (both negative and positive for metastasis) excised from a 52-year-old man. The cloning incidence provided an estimation of the level of specific miRNA expression, which was confirmed by Northern analysis and quantitative real-time polymerase chain reaction. This methodology can therefore be used to facilitate miRNA discovery from archived human cancers.

Scalp Melanoma: The Sunbelt Melanoma Trial

Eighty‐eight patients were enrolled with scalp melanoma. Men (79.5%) and Caucasians (100%) predominated with an average age of 49.8 years. The most common histologic subtypes were superficial spreading (39.7%), nodular (27.3%) and lentigo maligna (10.2%). The average thickness was 2.4 mm (+1.66) and 25% were ulcerated. Sentinel lymph node (SLN) positivity was seen in 20.9% of scalp melanoma patients, was more likely in younger patients (44.7 vs. 50.8 years, p = 0.04) and in those with a Breslow thickness of 2‐4 mm (p = 0.005). The incidence of locoregional and distant recurrence between the scalp and non‐scalp groups were similar. Overall survival for scalp melanoma patients was significantly impacted by SLN positivity (p = 0.03), while Breslow thickness and ulceration status predicted survival in non‐scalp melanoma patients (p = 0.005, p 4.0 mm 2.1 (1.0, 4.3), p = 0.04 1.0 (0.3, 3.5), p = 0.96 2.0 – 4.0 mm Reference Reference 0.0 – 2.0 mm ‐ ‐ Breslow Thickness Non‐Scalp Hazard Ratio (N = 235) Scalp Hazard Ratio (N = 61) Variable

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

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

Melanoma of the scalp and neck had greater risk for melanoma-specific mortality than melanoma of the extremities

Melanoma of the scalp and neck had greater risk for melanoma-specific mortality than melanoma of the extremities

Idiosyncrasies of Scalp Melanoma

Examine the accuracy of sentinel lymph node biopsy (SNB) in scalp melanoma (SM), patterns of nodal metastases, patient outcomes, and the utility of immunohistochemistry (IHC) in SNB evaluation. Retrospective. There were 22 patients, 4 females and 18 males. Sentinel lymph nodes (SLN) were localized via preoperative lymphoscintigraphy, intraoperative gamma probe, and Lymphazurin injection. SLNs were stained with hematoxylin-eosin, S-100, HMB-45, Melan-A, micropthalmia transcription factor, and tyrosinase. SLNs were grouped into cervical (levels 1-5) and extracervical (parotid, suboccipital, retroauricular) regions. There were 13 posterior and 9 anterior SMs. The first SNB were mapped to the extracervical regions in 77% of posterior and 78% of anterior lesions. SLN number ranged from 1 to 5. Ten patients had positive SLNs (PSLN). Forty percent of the PSLN group had SLNs mapped in both cervical and extracervical sites. Six underwent completion lymphadenectomy, with no additional positive nodes identified. No significant difference between PSLN and negative sentinel node (NSLN) patients was seen when compared by SLN number, Breslow's thickness, tumor ulceration, and clinical outcomes. Mean follow-up was 35 months. One patient died of disease. One isolated regional recurrence occurred. Sixty percent of PSLN and 92% of NSLN patients were recurrence free at last follow-up. One distant metastasis occurred in the NSLN group, and one local, one regional, and two patients with distant metastases were in the PSLN group at the time of last follow-up. Additional IHC did not detect other metastases in the NSLN group. SM is aggressive, as demonstrated by the high rate of SLN metastases, and there were no significant histopathologic factors in the primary tumor that predicted the presence of SLN metastases. SNB was accurate. The majority of first SLNs were localized in extracervical basins.