Comparison Among Clark's, Breslow's, and TNM Classifications for Cutaneous Head and Neck Malignant Melanoma

Abstract

This retrospective study was carried out to assess the prognostic value of three classification systems used for staging cutaneous head and neck malignant melanoma (CHNME). Fifty-three patients with histologically proven CHNME were analyzed. Thirty patients were never treated before admission, whereas 23 (43.4%) had a second radical resection of the primary tumor location, 9 (17%) had neck nodes, none had distant metastasis, and all had a minimum of 5 years of follow-up. Results show that T-stage is the most important clinical prognostic parameter, whereas Clark's and Breslow's classifications have lower impact in defining prognosis. Sites of primary tumor determines different clinical outcomes, but this does not reach statistically significant values. A second surgery on the primary tumor location is possible and is effective toward survival. No statistical differences were noted between the previously untreated and treated groups. Neck nodes have to be removed with neck dissection, and this regimen can improve the clinical outcome; however, only 40% of neck positive patients survive more than 5 years.

Tumor Location Predicts Survival in Cutaneous Head and Neck Melanoma

“…Along with suggesting that tumor location influences survival in CHNM, our data validate known prognostic factors for melanoma such as increasing age, male gender, histologic subtype, Breslow depth, Clark's level, tumor ulceration, and nodal status(9, 33-35). …”