Bill McCarthy, MD
In patients with melanoma, are tumors of the scalp or neck associated with increased risk for melanoma-specific mortality?
13 Surveillance, Epidemiology, and End Results (SEER) registries in the US.
51 704 white, non-Hispanic adults ≥ 20 years of age (mean age 56 y, 56% men) who had a first invasive microscopically confirmed cutaneous melanoma and were included in the National Cancer Institute SEER-13 registries between 1992 and 2003 (> 42% followed up for ≥ 5 years).
Tumor site (scalp/neck, extremities, trunk, face/ears, and unknown), other tumor characteristics (Breslow thickness, ulceration, lymph node involvement, and histologic subtype), and patient characteristics (age at diagnosis and sex).
9% of patients died from melanoma during follow-up. Melanoma-specific survival was lower for patients with scalp/neck melanoma than for those with melanoma in other locations (5 y survival 83% vs 92%). Multivariate analyses showed that melanoma-specific mortality was greater for tumors of the scalp/neck and trunk than for the extremities (Table). <<Mary, I know we don't usually use “compared with”; however, I deliberately chose that here because the analysis used extremities as the reference group rather than simply comparing the 2 groups on a specific value. Jean>> Older age (hazard ratio [HR] 1.17, 95% CI 1.14 to 1.20), increased Breslow thickness (HR 1.41, CI 1.39 to 1.43), and presence of ulceration (HR 2.61, CI 2.36 to 2.90) also increased risk for melanoma-specific mortality; being female reduced risk (HR 0.67, CI 0.62 to 0.73). For patients with known lymph node status, positive nodes were associated with increased risk for melanoma mortality (n = 27 913, HR 4.81, CI 4.29 to 5.40).
In patients with a first invasive melanoma, tumors of the scalp/neck or trunk, older age, being male, tumor thickness, and ulceration were associated with increased risk for melanoma-specific mortality.
Melanoma-specific mortality for patients with a first invasive melanoma*
*Abbreviations defined in Glossary. 5-year follow-up for > 42% of patients.
†4% of patients had unknown tumor site.
‡Multivariate analyses (n = 42 237) adjusted for age, sex, Breslow thickness, and ulceration, and excluded patients who were alive but with 0 mo as recorded survival time or who had tumors of unknown anatomical site, thickness, or ulceration status.
McCarthy B. Melanoma of the scalp and neck had greater risk for melanoma-specific mortality than melanoma of the extremities. Ann Intern Med. ;149:JC2–15. doi: 10.7326/0003-4819-149-4-200808190-02015
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Published: Ann Intern Med. 2008;149(4):JC2-15.
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