Head and neck melanoma in 534 clinical Stage I patients. A prognostic factors analysis and results of surgical treatment.
Marshall M. Urist,Charles M. Balch,Seng-Jaw Soong,Gerald W. Milton,Helen M. Shaw,V. J. McGovern,Tariq M. Murad,William H. McCarthy,William A. Maddox +8 more
Reads0
Chats0
TLDR
Growth patterns, tumor thickness, ulceration, and anatomic subsites should be considered when evaluating risk factors and when making treatment decisions in head and neck melanoma patients.Abstract:
Single and multifactorial analyses were used to evaluate prognosis and results of surgical treatment in 534 clinical Stage I patients with head and neck cutaneous melanoma treated at the University of Alabama in Birmingham (U.S.A.) and the University of Sydney (Australia). This computerized data base was prospectively accumulated in over 90% of cases. Melanomas were about equally distributed between men and women. They were located on the skin of the face in 47%, neck in 27%, scalp in 13%, and the ear in 13% of patients. Both the results of the prognostic factors analyses and the surgical treatment demonstrated that lentigo maligna melanoma (LMM) was distinct from the other two growth patterns, superficial spreading melanoma and nodular melanoma (SSM and NM). In a multifactorial analysis of the 453 patients with SSM and NM, the dominant prognostic variables were tumor thickness (p less than 0.00001), anatomic subsite (p = 0.0213), and ulceration (p = 0.0289). Patients with melanomas on the scalp or neck subsites fared worse than those with tumors located on the face or ear. The results differed for LMM, where thickness was not a significant predictor of survival, and the most dominant prognostic variable was ulceration (p = 0.0042). Local recurrence rates were low, being 2.4% for tumors less than 2.5 mm in thickness, but were 12.3% for tumors greater than or equal to 4.0 mm in thickness. Patients with SSM and NM lesions located on the head and neck had a lower survival rate than those with extremity melanomas in every tumor thickness category, although only those in the 0.76 to 1.49 mm thickness subgroup were significantly different (p = 0.0007). After 5 years of follow-up, patients who underwent an elective lymph node dissection for SSM and NM with a thickness range of 1.5 to 3.99 mm had a better survival (72%) than patients with melanomas of equivalent thickness whose initial treatment was wide excision alone (45%). LMM had a less aggressive biologic behavior compared to SSM or NM and was treated more conservatively. Thus, LMM lesions had an 85% 10-year survival rate with wide excision only, and there was no significant improvement in survival with ELND. Growth patterns, tumor thickness, ulceration, and anatomic subsites should be considered when evaluating risk factors and when making treatment decisions in head and neck melanoma patients.read more
Citations
More filters
Journal ArticleDOI
Final Version of the American Joint Committee on Cancer Staging System for Cutaneous Melanoma
Charles M. Balch,Antonio C. Buzaid,Seng Jaw Soong,Michael B. Atkins,Natale Cascinelli,Daniel G. Coit,Irvin D. Fleming,Jeffrey E. Gershenwald,Alan Houghton,John M. Kirkwood,Kelly M. McMasters,Martin F. Mihm,Donald L. Morton,Douglas S. Reintgen,M. I. Ross,Arthur J. Sober,John A. Thompson,John F. Thompson +17 more
TL;DR: This revision of the staging system for cutaneous melanoma will become official with publication of the sixth edition of the AJCC Cancer Staging Manual in the year 2002.
Journal ArticleDOI
Prognostic Factors Analysis of 17,600 Melanoma Patients: Validation of the American Joint Committee on Cancer Melanoma Staging System
Charles M. Balch,Seng Jaw Soong,Jeffrey E. Gershenwald,John F. Thompson,Douglas S. Reintgen,Natale Cascinelli,Marshall M. Urist,Kelly M. McMasters,M. I. Ross,John M. Kirkwood,Michael B. Atkins,John A. Thompson,Daniel G. Coit,David R. Byrd,Renee A. Desmond,Yuting Zhang,Ping-Yu Liu,Gary H. Lyman,Aberto Morabito +18 more
TL;DR: The proposed tumor-node-metastases categories and stage groupings for cutaneous melanoma patients were validated and incorporated into the AJCC melanoma staging as described in the companion publication.
Journal ArticleDOI
A new American Joint Committee on Cancer staging system for cutaneous melanoma.
Charles M. Balch,Antonio C. Buzaid,Michael B. Atkins,Natale Cascinelli,Daniel G. Coit,Irvin D. Fleming,Alan N. Houghton,John M. Kirkwood,Martin F. Mihm,Donald L. Morton,Douglas S. Reintgen,Merrick I. Ross,Arthur J. Sober,Seng-Jaw Soong,John A. Thompson,John F. Thompson,Jeffrey E. Gershenwald,Kelly M. McMasters +17 more
TL;DR: The Melanoma Staging Committee of the AJCC has proposed major revisions of the melanoma TNM and stage grouping criteria to better reflects independent prognostic factors that are used in clinical trials and in reporting the outcomes of various melanoma treatment modalities.
Journal ArticleDOI
Long-term results of a prospective surgical trial comparing 2 cm vs. 4 cm excision margins for 740 patients with 1-4 mm melanomas.
Charles M. Balch,Seng-Jaw Soong,Thomas J. Smith,Merrick I. Ross,Marshall M. Urist,Constantine P. Karakousis,Walley J. Temple,Martin C. Mihm,Raymond L. Barnhill,William R. Jewell,Harry J. Wanebo,Renee A. Desmond +11 more
TL;DR: For this group of melanoma patients, a local recurrence is associated with a high mortality rate, a 2-cm margin of excision is safe and ulceration of the primary melanoma is the most significant prognostic factor heralding an increased risk for a local Recurrence.
Journal ArticleDOI
Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck.
TL;DR: Intraoperative lymphatic mapping and SLND is a minimally invasive and highly accurate screening technique for determining which patients with CS-I head and neck melanomas have subclinical node metastases and therefore might benefit from cervical LND.
References
More filters
Journal ArticleDOI
Inefficacy of Immediate Node Dissection in Stage 1 Melanoma of the Limbs
Umberto Veronesi,Jerzy Adamus,D. C. Bandiera,I. O. Brennhovd,E. Caceres,Natale Cascinelli,F. Claudio,R. L. Ikonopisov,V. V. Javorskj,S. Kirov,A. Kulakowski,Lacoub J,Ferdy J. Lejeune,Z. Mechl,Alberto Morabito,I. Rodé,S. Sergeev,van Slooten E,Szcygiel K,N. N. Trapeznikov +19 more
TL;DR: Elective lymph-node dissection in malignant malanoma of the limbs does not improve the prognosis and is not recommended when patients can be followed at intervals of three months.
Journal ArticleDOI
A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark's and Breslow's staging methods.
Charles M. Balch,Tariq M. Murad,Seng-Jaw Soong,Anna Lee Ingalls,Norman B. Halpern,William A. Maddox +5 more
TL;DR: Clinical trials evaluating alternative surgical treatments or adjunctive therapy modalities for melanoma patients should incorporate these parameters into their assessment, especially in Stage I (localized) disease where tumor thickness and the anatomical site of the primary melanoma are dominant prognostic factors.
Journal ArticleDOI
The prognostic significance of ulceration of cutaneous melanoma
Charles M. Balch,James A. Wilkerson,Tariq M. Murad,S. J. Soong,Anna Lee Ingalls,William A. Maddox +5 more
TL;DR: The Breslow microstaging method of measuring thickness is a valid prognostic indicator, even for ulcerated lesions and should be considered as a stratification criterion in clinical trials and accounted for when analyzing results of melanoma treatment.
Journal ArticleDOI
A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma. Preliminary results.
TL;DR: The preliminary conclusion is that elective node dissection is not beneficial in management of melanoma, and disease progression was advanced significantly by age of the patient and by invasiveness and thickness of the melanoma.
Journal ArticleDOI
A comparison of prognostic factors and surgical results in 1,786 patients with localized (stage I) melanoma treated in Alabama, USA, and New South Wales, Australia.
Charles M. Balch,Seng-Jaw Soong,Gerald W. Milton,Helen M. Shaw,V. J. McGovern,Tariq M. Murad,William H. McCarthy,William A. Maddox +7 more
TL;DR: The biologic behavior of melanoma in these two different parts of the world was virtually the same, with only minor differences that did not significantly influence survival rates.