Comparison of clinicopathological features and treatment outcomes for cutaneous melanomas of the head and neck and melanomas arising at other sites: Implications for systemic therapy - 18/12/24
Abstract |
Background |
Melanoma is increasingly recognized as a heterogeneous disease, with conflicting evidence regarding whether cutaneous head and neck melanoma (CHNM) represents a distinct entity.
Objective |
Comparison of clinicopathological features and treatment outcomes of CHNM and cutaneous melanomas of other sites (CMOS).
Methods |
Patients with CHNM and CMOS diagnosed between 2000 and 2018 were included. Locoregional control, distant metastasis-free survival, melanoma-specific survival (MSS), and overall survival (OS) were described using the Kaplan-Meier method. Cox regression analyses were performed to examine associations between prognostic factors and outcomes. Additional analyses of survival from time of stage IV disease diagnosis were undertaken, stratified by receipt of BRAF-targeted therapy and immune checkpoint inhibitor immunotherapy.
Results |
Of 3007 CHNM and 10,637 CMOS patients, CHNM had more adverse pathological features (median age 65.9 vs 58.5, P < .001; median Breslow thickness 1.7 mm vs 1.2 mm, P < .001; and ulceration 21.2% vs 18.2%, P < .001). CHNM had worse locoregional control (hazard ratio (HR) 1.17, P < .001) and distant metastasis-free survival (HR 1.25, P < .001) but there were no significant differences in MSS or OS. Among stage IV patients who received immune checkpoint inhibitor, CHNM had better MSS (HR 0.56, P = .001) and OS (HR 0.57, P < .001) on multivariable analyses.
Limitations |
Retrospective study, offset by prospective data collection.
Conclusion |
CHNM is associated with a distinct clinicopathological and prognostic profile.
Le texte complet de cet article est disponible en PDF.Key words : anatomic subsites, head and neck, immunotherapy, melanoma, melanoma survival, prognostic factors, targeted therapy
Abbreviations used : CHNM, CMOS, DMFS, ECOG, HR, ICI, LDH, LRC, LVI, MSS, OS, SNB, TT
Plan
Funding sources: Dr Saw is supported by Melanoma Institute Australia. Dr Menzies is supported by Nicholas and Helen Moore and Melanoma Institute Australia. Support is provided from the Cameron family. Dr Long is supported by a National Health and Medical Research Council of Australia (NHMRC) Investigator Grant and the University of Sydney Medical Foundation. Dr Scolyer is supported by an NHMRC Practitioner Fellowship (APP1141295). |
|
Patient consent: All included patients gave prior written consent for their deidentified data to be used for research purposes. |
|
IRB approval status: This study was approved by the Melanoma Institute Australia Research Committee (MIA2020/323) and the Sydney Local Health District Human Research Ethics Committee (2019/ETH07604). |
Vol 92 - N° 1
P. 58-67 - janvier 2025 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?