A total of 371 patients (female: n=191; male: n=180) with a histological diagnosis of CHNM were included in the study and were followed up for a mean of 93.6 months. CHNM were classified according to ultraviolet radiation exposure into peripheral (i.e., scalp, ear and neck) or central (i.e., forehead, eyelids, nose, cheeks, and perioral region) lesions. Researchers found that peripheral melanomas were much more common in men, were diagnosed at a younger age, had deeper tumor thickness, were more frequently ulcerated, and had a higher (≥6) number of mitoses than those melanomas located centrally.
Data also showed that patients with peripherally located melanomas developed more metastasis, had a higher melanoma-specific mortality, as well as a lower 10-year survival rate (50% vs. 90%; p<0.001) than those with centrally located melanomas.
“Cutaneous head and neck melanomas have been associated with poor outcomes, especially those located on the scalp. The reason for this difference, and whether it is applicable to all locations within the head and neck, remains unclear to this date,” wrote José Antonio Avilés-Izquierdo, M.D., Ph.D., Enrique Rodríguez-Lomba, M.D., and colleagues, in the study to soon be published in The Journal of the American Academy of Dermatology.
Several different factors in the study remained as independent predictors for melanoma-specific survival (p<0.001) including peripheral location of the lesion, tumor thickness, high mitotic rate (≥6/mm2) as well as patient age (≤65 years). Study data also showed that peripheral location had the strongest association with melanoma-specific mortality (OR 11.93; CI 95% 4.77-29.86).
“The reasons underlying differences between peripheral and central CHNM are still unknown. The uneven distribution of CHNM between sexes could be due to the protective role of hair in the scalp, neck and ears, which are generally covered by hair, even in elderly women. Another possible explanation is a greater delay in diagnosis of peripheral CHNM, as lesions located on the scalp or ears are not easily visible to the patient,” the study authors wrote.
1. Tseng WH, Martinez SR. Tumor location predicts survival in cutaneous head and neck melanoma. J Surg Res. 2011;167(2):192-8.
2. Avilés-Izquierdo JA, Rodríguez-lomba E, Milla J, Hernández-aragüés I. Peripheral cutaneous head and neck melanoma: Definition, characteristics and impact on survival. J Am Acad Dermatol. 2019.