Department of Surgery, Division of Surgical Oncology, University of California Davis, Sacramento, California, USA.
J Surg Res. 2011 May 15;167(2):192-8. doi: 10.1016/j.jss.2010.10.008. Epub 2010 Nov 10.
Prior studies documented poorer outcomes in patients with cutaneous head and neck melanoma (CHNM) relative to those with melanoma at other sites. We evaluated survival differences attributable to tumor location in patients with CHNM.
We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients undergoing surgery for CHNM from 1988 to 2006, excluding patients without biopsy-proven diagnoses, those diagnosed at autopsy, and patients with distant metastases. Using the Kaplan-Meier method, we assessed patient, tumor, and treatment-specific factors on overall survival (OS) and melanoma specific survival (MSS). Cox proportional hazards models assessed the role of tumor location (ear, eyelid, face, lip, scalp/neck) on OS and MSS, while controlling for patient age, gender, race, tumor thickness, tumor ulceration, lymph node status, histologic subtype, type of surgery, and use of radiation. Risks of overall and melanoma-specific mortality were reported as hazard ratios (HR) with 95% confidence intervals (CI).
Among 27,097 patients, 10-y rates of OS and MSS were 56.1% and 84.7%, respectively. On multivariate analysis, scalp/neck primary site was associated with an increased risk of overall (HR 1.20, CI 1.14-1.26; P < 0.001) and melanoma-specific mortality (HR 1.64, CI 1.49-1.80, P < 0.001) relative to melanomas of the face. Tumors of the lip had poorer MSS (HR 1.55; CI 1.05-2.28, P = 0.03) but not OS (HR 1.03, CI 0.80-1.34; P = 0.80).
Patients with melanomas of the scalp/neck have poorer OS and MSS and those with lip melanomas have poorer MSS. These anatomic areas should not be overlooked when performing skin examinations.
先前的研究记录表明，头颈部皮肤黑色素瘤（CHNM）患者的预后比其他部位黑色素瘤患者差。我们评估了 CHNM 患者肿瘤部位对生存的影响。
我们查询了 1988 年至 2006 年接受 CHNM 手术的患者的监测、流行病学和最终结果（SEER）数据库，排除了没有活检证实诊断、尸检诊断和远处转移的患者。使用 Kaplan-Meier 方法，我们评估了患者、肿瘤和治疗特异性因素对总生存率（OS）和黑色素瘤特异性生存率（MSS）的影响。Cox 比例风险模型评估了肿瘤部位（耳、眼睑、面部、嘴唇、头皮/颈部）对 OS 和 MSS 的作用，同时控制了患者年龄、性别、种族、肿瘤厚度、肿瘤溃疡、淋巴结状态、组织学亚型、手术类型和放疗的使用。总死亡率和黑色素瘤特异性死亡率的风险以危险比（HR）和 95%置信区间（CI）报告。
在 27097 名患者中，10 年 OS 和 MSS 率分别为 56.1%和 84.7%。多变量分析显示，头皮/颈部原发部位与总死亡率（HR 1.20，CI 1.14-1.26；P < 0.001）和黑色素瘤特异性死亡率（HR 1.64，CI 1.49-1.80，P < 0.001）显著相关。与面部黑色素瘤相比，唇部肿瘤的 MSS 较差（HR 1.55；CI 1.05-2.28，P = 0.03），但 OS 无差异（HR 1.03，CI 0.80-1.34；P = 0.80）。
头皮/颈部黑色素瘤患者的 OS 和 MSS 较差，唇部黑色素瘤患者的 MSS 较差。在进行皮肤检查时，不应忽视这些解剖区域。
