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

OBJECTIVE: Head and neck cutaneous melanoma represents a distinct entity of skin cancer. We aim to examine management and survival of patients with head and neck cutaneous melanoma. METHODS: A retrospective cohort study utilizing the National Cancer Database, 2004-2012. RESULTS: A total of 20,322 (21.2%) head and neck melanomas and 75,547 (78.8%) melanomas of other sites were included. The median follow-up time of head and neck melanoma was 41.6 months (interquartile range: 22.9-68.2 months). Patients with melanoma of the head and neck were more likely to be ≥65 years old, male, and/or white (p < 0.001 each). Positive surgical margin was more prevalent in head and neck melanoma [OR: 2.19, 95% CI: (2.03, 2.37)], and was associated with a lower survival [HR: 1.41, 95% CI: (1.28, 1.57)]. High positive lymph node ratio was associated with a lower survival [HR: 2.00, 95% CI: (1.13, 3.57)]. Adjuvant immunotherapy was associated with an improved survival [HR: 0.67, 95% CI: (0.57, 0.80)]. CONCLUSION: Head and neck cutaneous melanoma is associated with certain demographics. Surgical margin status, lymph node ratio, and immunotherapy are independently associated with overall survival.