Is head and neck melanoma a distinct entity? A clinical registry-based comparative study in 5702 patients with melanoma
Is head and neck melanoma a distinct entity? A clinical registry-based comparative study in 5702 patients with melanoma
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DOI：
10.1111/j.1365-2133.2006.07455.x
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发表时间：
2006-10-01
影响因子：
10.3
通讯作者：
Garbe, C.
中科院分区：
文献类型：
--
作者：
Hoersch, B.;Leiter, U.;Garbe, C.
头颈部比身体其他部位更容易受到紫外线（UV）辐射。因此，我们认为，头颈部皮肤恶性黑色素瘤（CMM）的临床病理特征和患者生存率与其他部位黑色素瘤有显著差异。目的本回顾性研究基于临床登记数据，旨在比较头颈部黑色素瘤（HNM）与其他解剖部位黑色素瘤（莫尔）的临床特征和预后因素。方法对844例Ⅰ、Ⅱ期侵袭性HNM患者的临床资料和组织病理学检查结果与4858例莫尔患者进行比较。生存分析使用Kaplan-Meier估计，和多变量考克斯比例风险模型被用来评估独立的预后factors.Results黑色素瘤的密度明显高于HNM比莫尔：这是特别真实的脸，它是由2.6的一个因素升高。HNM患者的男女比例较高，且年龄明显大于莫尔患者（P < 0.0001）。Breslow肿瘤厚度在HNM和莫尔之间没有差异。然而，头皮处的CMMs明显更厚，并且溃疡程度更高。关于临床病理CMM亚型，有一个增加的比例，恶性雀斑样痣黑色素瘤HNM和结节性黑色素瘤在头皮和颈部区域。HNM组的切除范围较莫尔组窄，一期完全切除率较低。总体而言，根据Kaplan-Meier估计，HNM（84.6%）和莫尔（87.8%）患者的累积10年生存率无显著统计学差异。肿瘤厚度原来是最高的预后影响的变量，其次是溃疡HNM和莫尔。结论在皮肤表面显着更多的CMMs被发现在头部和颈部区域比其他解剖区域。这可能表明，但不能证明，紫外线照射促进了CMM的发展。虽然HNM具有特殊的临床病理特征，但预后不受影响。因此，HNM似乎不是CMM的一个独特亚型。
Background The head and neck region is more heavily exposed to ultraviolet (UV) radiation than any other body site. Therefore, cutaneous malignant melanoma (CMM) of the head and neck area is proposed to have notable differences from melanoma at other body sites regarding clinicopathological features and survival of patients.Objectives The present retrospective study based on clinical registry data aims to compare clinical features and prognostic factors of head and neck melanoma (HNM) vs. melanoma at other anatomical regions (MOR) in order to detect differences which may be associated to the mode of sun exposure.Methods The clinical records and histopathological findings of 844 patients with clinical stage I and II invasive HNM were compared with the data of 4858 patients with MOR. Survival analysis was performed using the Kaplan-Meier estimate, and the multivariate Cox proportional hazard model was used to evaluate independent prognostic factors.Results Melanoma density was clearly higher for HNM than for MOR: this was particularly true for the face, where it was elevated by a factor of 2.6. There was a higher male/female ratio in patients with HNM and they were significantly older than patients with MOR (P < 0.0001). Breslow tumour thickness did not differ between HNM and MOR. However, CMMs at the scalp were significantly thicker and to a higher degree ulcerated. Concerning clinicopathological CMM subtypes, there was an increased proportion of lentigo maligna melanoma among HNM and of nodular melanoma in the scalp and neck regions. Excision margins were narrower and the rate of complete primary excision was lower in HNM than in MOR. Overall, there was no significant statistical difference in cumulative 10-year survival rates according to Kaplan-Meier estimates among patients with HNM (84.6%) and MOR (87.8%). Tumour thickness turned out to be the variable with the highest prognostic impact followed by ulceration in both HNM and MOR.Conclusions In relation to the skin surface significantly more CMMs were found in the head and neck area than in other anatomical regions. This might indicate, but does not prove, that UV exposure promotes the development of CMM. Although HNM showed specific clinicopathological features, prognosis remained unaffected. Thus HNM seems not to be a distinct subtype of CMM.