Li Andrew T, Xu Jessie X, Blah Tyler R, Lo Serigne N, Saw Robyn Pm, Varey Alexander Hr, Van Akkooi Alexander, Carlino Matteo S, Pires da Silva Ines, Menzies Alexander M, Shannon Kerwin F, Long Georgina V, Scolyer Richard A, Thompson John F, Ch'ng Sydney
Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Victorian Melanoma Service, The Alfred Hospital, Melbourne, VIC, Australia.
Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia; Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
J Am Acad Dermatol. 2025 Jan;92(1):58-67. doi: 10.1016/j.jaad.2024.06.107. Epub 2024 Sep 6.
Melanoma is increasingly recognized as a heterogeneous disease, with conflicting evidence regarding whether cutaneous head and neck melanoma (CHNM) represents a distinct entity.
Comparison of clinicopathological features and treatment outcomes of CHNM and cutaneous melanomas of other sites (CMOS).
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.
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.
Retrospective study, offset by prospective data collection.
CHNM is associated with a distinct clinicopathological and prognostic profile.
黑色素瘤越来越被认为是一种异质性疾病，关于皮肤头颈部黑色素瘤（CHNM）是否代表一种独特的实体存在相互矛盾的证据。
比较CHNM与其他部位皮肤黑色素瘤（CMOS）的临床病理特征和治疗结果。
纳入2000年至2018年间诊断为CHNM和CMOS的患者。采用Kaplan-Meier方法描述局部区域控制、无远处转移生存期、黑色素瘤特异性生存期（MSS）和总生存期（OS）。进行Cox回归分析以检查预后因素与结果之间的关联。对IV期疾病诊断后的生存期进行了额外分析，按是否接受BRAF靶向治疗和免疫检查点抑制剂免疫治疗进行分层。
在3007例CHNM患者和10637例CMOS患者中，CHNM具有更多不良病理特征（中位年龄65.9岁对58.5岁，P <.001；中位Breslow厚度1.7mm对1.2mm，P <.001；溃疡率21.2%对18.2%，P <.001）。CHNM的局部区域控制较差（风险比（HR）1.17，P <.001）和无远处转移生存期较差（HR 1.25，P <.001），但MSS或OS无显著差异。在接受免疫检查点抑制剂的IV期患者中，多变量分析显示CHNM的MSS（HR 0.56，P =.001）和OS（HR 0.57，P <.001）更好。
回顾性研究，前瞻性数据收集可弥补其不足。
CHNM与独特的临床病理和预后特征相关。
