Primary cutaneous melanoma. Prognostic classification of anatomic location

Abstract

Background. Anatomic location has been identified by several investigators as a significant prognostic factor for patients with primary cutaneous melanoma (CM). However, the best determination of higher and lower risk sites is still controversial, and the biologic significance of tumor site in the course of primary CM is unknown. The aim of the present study was to identify higher and lower risk sites based on multivariate analysis. Methods. A series of 5093 patients with invasive primary cutaneous melanoma followed from 1970 to 1988 at four university centers in Germany was investigated using the multivariate Cox proportional hazard model to analyze the importance of anatomic location for survival probability. Results. The anatomic location was found to be a highly significant prognostic factor for patients with primary melanoma by multivariate analysis (P < 0.0001). An optimized classification into sites of higher and lower risk with respect to survival was evaluated by multivariate analysis controlling for the possible confounding effects of the other significant prognostic factors. Relative to the lower leg as the prognostically favorable baseline, the following locations were associated with a significantly higher risk of death caused by primary cutaneous melanoma: back and breast (thorax), upper arm, neck, and scalp (TANS regions). The lower trunk, thigh, lower leg, foot, lower arms, hands, and face were identified as lower risk sites. Conclusions. Anatomic location was confirmed as an independent prognostic factor for patients with primary cutaneous melanoma. The TANS regions were identified as high risk sites, and the lower trunk, thigh, lower leg, foot, lower arms, hands, and face were identified as intermediate sites.

The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma

“…Body location has been reported quite variably and infrequently as a risk factor for melanoma in the literature. 27,28 Differences in the data collected explain some of the discordant conclusions. For example, the large database analyzed to produce the 2001 American Joint Committee on Cancer melanoma staging system categorized location into either head/neck/trunk or extremities.…”

Differences in survival by race/ethnicity among cutaneous melanoma patients in the United States over a period from 1982 to 2011

“…One article studied the head and neck in more details by splitting them into additional sites, which showed differences in prognosis. 18,19 However, in other studies the head and neck were studied as one site. 20 Finally, the follow up period was not equal among the three decades of diagnosis.…”

Sentinel-Node-Biopsy: Bedeutung für Prognose und Therapie

“…Die PCRPositivität des WLK ist jedoch überraschend hoch und übersteigt damit deutlich die Rate von Patienten, bei denen im weiteren Krankheitsverlauf eine Metastasierung erwartet werden muss. In der Tat, eine Metastasierung wurde bei ungefähr 30 % aller Patienten mit primärem Melanom (Tumordicke > 1 mm) beschrieben [9,14]. Insofern darf nicht erwartet werden, dass bei allen Patienten mit positiven molekularbiologischen Befunden eine Krankheitsprogression eintritt.…”