The importance of ulceration of cutaneous melanoma of the head and neck: a comparison of ear (pinna) and nonear sites.

OBJECTIVES/HYPOTHESIS: To compare clinicopathologic and prognostic factors associated with ear melanomas and nonear melanomas of the head and neck (H&N).

STUDY

DESIGN

Post hoc analysis of the database from a multi-institutional, prospective, randomized study.

METHODS

Clinicopathologic factors were assessed and correlated with survival and recurrence. Univariate and multivariate analysis of prognostic factors affecting disease-free survival (DFS) and overall survival (OS) were performed.

RESULTS

Of 405 patients with H&N melanomas ≥ 1.0 mm Breslow thickness, 59 patients had melanomas of the ear. Most were Caucasian (96.6%) males (79.7%) with a mean age of 52 years. The mean Breslow thickness was 2.5 mm; 34.5% had signs of ulceration. Sentinel lymph node (SLN) positivity was seen in 7.1%. The incidence of locoregional and distant recurrence were similar. OS for ear melanoma was significantly impacted by ulceration status (P = .013), whereas both ulceration and SLN positivity predicted survival in nonear melanoma (P < .001 and P = .015, respectively). Thicker melanomas in the nonear group demonstrated significantly decreased DFS, whereas other factors in both groups lost their predictive value (P = .035).

CONCLUSIONS

In the Sunbelt Melanoma Trial, ulceration was the strongest predictor of overall survival in melanoma of the ear. Ulceration and SLN status correlated with poorer OS in nonear melanoma of the H&N, whereas increasing depth correlated with poorer DFS in those same patients. Recurrence and survival were not impacted by anatomic site, but the prognostic significance of ulceration, thickness, and SLN status in the H&N may vary with the site of the melanoma.