Thin malignant melanomas of the head and neck

Abstract

Historically, Breslow classified thin melanomas as invasive lesions less than 0.76 mm in depth with rare instances of recurrence and mortality. From 1970 to 1990, 87 patients with thin head and neck melanoma were treated at Duke Medical Center. A computer-aided retrospective analysis was performed. Recurrence occurred in 30% of these patients; however, of the 66 patients seen at this institution prior to recurrence, only 8% recurred. Recurrence significantly shortened survival. Compared to an overall 84% 5-year survival, there was less than a 50% 5-year survival after recurrence. For thin melanomas, thickness did not affect survival. There was no difference in survival between thin melanomas and those ranging from 0.76 to 1.5 mm. A multivariate analysis was performed. The data suggest that thin melanomas of the head and neck may recur at a higher rate than previously reported and in addition, that they can be lethal.

Risk and Survival of Patients with Head and Neck Cutaneous Melanoma: National Perspective

“…head and neck melanoma is most likely to present with a more advanced clinical stage and a deeper Breslow thickness relative to melanoma of other locations. This is consistent with multiple studies that have demonstrated a more aggressive pathological behavior of malignant melanoma of the head and neck region [2,7,8,[11][12][13] . We also reported positive surgical margins were more prevalent after head and neck melanoma excision.…”

“…more likely to exhibit aggressive clinicopathological features, particularly scalp melanoma, and is associated with an unfavorable prognosis and a higher recurrence rate relative to melanomas of other skin sites [2,[7][8][9][10][11][12][13] .…”

Cutaneous head and neck melanoma treated with Mohs micrographic surgery

“…There were no incomplete excisions in the primary melanoma in situ (MIS) group, and only a single incomplete excision in the invasive melanoma group, despite head and neck location being a risk factor for excision failures. 5,6 This incomplete excision occurred in the 1.01 mm to 2.00 mm group, and it was re-excised in conjunction with a satellite metastasis. The patient was free of disease at the time of death from non-melanoma related causes 28 months later.…”

“…These characteristics of indistinct margins are much less likely on the trunk or proximal extremities, and therefore, complete excision is more common, resulting in lower recurrence rates in these sites. [5][6][7] This contrasts the problem of correctly identifying clinical margins on the head and neck.…”

Histological Characteristics of Metastasizing Thin Melanomas

“…In some studies, [39][40][41][42] thin melanomas from the head and neck have shown a higher rate of recurrence and metastasis. The higher rate of recurrence reported in head and neck melanomas may be associated with narrower surgical margins in anatomical sites cosmetically compromised and with difficult surgical repair.…”