Prognostic implications of anatomic location of primary cutaneous melanoma of 1 mm or thicker

Glenda G. Callender, Michael E. Egger, Alison L. Burton, Charles R. Scoggins, Merrick I. Ross, Arnold J. Stromberg, Lee Hagendoorn, C. G. Robert Martin, Kelly M. McMasters

Research output: Contribution to journalArticlepeer-review

82 Scopus citations

Abstract

Background: Breslow thickness, ulceration, and sentinel lymph node (SLN) status are well established as the most important prognostic factors for patients with cutaneous melanoma. Anatomic location of the primary tumor is generally considered to play a minor role in determining prognosis compared with these other factors. This analysis was performed to better define the influence of anatomic location of the primary melanoma on prognosis. Methods: In this post hoc analysis of a prospective randomized trial that included patients ages 18 to 70 years with melanomas 1 mm or greater in Breslow thickness, all patients underwent SLN biopsy and completion lymphadenectomy if tumor-positive SLN were found. KaplanMeier survival analysis and univariate and multivariate analyses were performed to evaluate factors predictive of disease-free survival (DFS), local and in-transit recurrence-free survival (LITRFS), and overall survival (OS). Results: A total of 2,500 patients were included in this analysis with a median follow-up period of 68 months. Anatomic locations included head, neck, trunk, upper extremity, and lower extremity. Age, Breslow thickness, and percentage of patients with a positive SLN were significantly different by anatomic location on univariate analysis, as were positive SLN status, presence of regression, sex, and histologic subtype (P <.0001). On multivariate analysis, anatomic location was an independent predictor of SLN status (P <.0001), DFS (P =.045), LITRFS (P =.023), and OS (P <.0001). By KaplanMeier analysis, anatomic location was associated significantly with DFS, LITRFS, and OS. Conclusions: Anatomic location of the primary melanoma is an important independent predictor of SLN status and prognosis. Patients with primary melanomas of the head/neck and trunk have a worse prognosis than primary melanomas of other anatomic locations.

Original languageEnglish
Pages (from-to)659-665
Number of pages7
JournalAmerican Journal of Surgery
Volume202
Issue number6
DOIs
StatePublished - Dec 2011

Keywords

  • Anatomic location
  • Anatomic site
  • Melanoma
  • Prognosis

ASJC Scopus subject areas

  • Surgery

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