Value of anatomic site, histology and clinicopathological parameters for prediction of lymph node metastasis and overall survival in head and neck melanomas Tobias Ettl a, * , Serkan Irga a , Steffen Müller a , Christian Rohrmeier b , Torsten E. Reichert a , Stephan Schreml c , Martin Gosau a a Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany b Department of Otorhinolaryngology (Chair: Prof. J. Strutz, MD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany c Department of Dermatology (Chair: Prof. M. Landthaler, MD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany article info Article history: Paper received 29 May 2013 Accepted 13 September 2013 Keywords: Melanoma Head and neck Prognosis Resection margin Neck dissection abstract Introduction: Head and neck melanoma compromises a group of aggressive tumours with varying clinical courses. This analysis was performed to find anatomic and clinicopathological parameters pre- dictive for lymph node metastasis and overall survival. Material and methods: Data and outcome of 246 patients with a malignant melanoma in the head and neck region were retrospectively analyzed for predictive parameters. Results: Lentigo maligna melanoma (n ¼ 115) was the most frequent histology, followed by superficial spreading (n ¼ 63) and nodular melanoma (n ¼ 52). More than half of the melanomas (n ¼ 138) were in the face. Tumours of the face and anterior scalp metastasized to lymph nodes of the neck and parotid gland, whereas tumours of the posterior scalp and neck also metastasized to the nuchal region. Advanced Clark level, presence of tumour ulceration and younger age were the strongest predictors of lymph node metastasis in multivariate regression analysis (p < 0.05), but anatomic site, histological subtype and tumour thickness were also associated with lymph node metastasis. Lymph node metastases, distant metastases, ulceration, nodular subtype and non-facial site of origin were the strongest negative prog- nostic parameters for disease-specific overall survival (p < 0.05). In contrast, the width of resection margin (<1 cm vs. 1e2 cm vs. >2 cm) did not correlate with tumour recurrence and overall survival (p > 0.05). Conclusion: Histological subtype diagnosis, anatomic site of origin as well as the established factors tumour thickness, ulceration and depth of invasion are prognostic indicators of cervical lymph node metastasis and overall survival. A resection margin of at least 1 cm seems sufficient in head and neck melanoma. The status of sentinel lymph node biopsy and neck dissection has to be proven within the next years. Ó 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. 1. Introduction Malignant melanoma of the skin is a rare but often aggressive cancer. Primary melanomas arising in the head neck region are reported to have a worse prognosis than those originating else- where (Callender et al., 2011; Thorn et al., 1989). Some prognostic factors, such as age, sex, Breslow tumour depth, Clark level, regional lymph and distant metastases have been reported in the literature (Balch et al., 1978; Huvos et al., 1974). The prognostic importance of tumour localization in the head neck area is not quite clear. As mentioned above cervical lymph node metastases and distant metastases are a major negative predictor for long-term survival. Sentinel lymph node biopsy represents a staging proce- dure which should identify patients at risk of occult neck node metastases. However sentinel lymph node biopsy might be espe- cially challenging in the head neck region due to the course of cranial nerves and variable lymphatic drainage patterns (Willis and * Corresponding author. E-mail addresses: tobias.ettl@ukr.de, tobias.ettl@klinik.uni-regensburg.de (T. Ettl). Contents lists available at ScienceDirect Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com 1010-5182/$ e see front matter Ó 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jcms.2013.09.007 Journal of Cranio-Maxillo-Facial Surgery xxx (2013) 1e7 Please cite this article in press as: Ettl T, et al., Value of anatomic site, histology and clinicopathological parameters for prediction of lymph node metastasis and overall survival in head and neck melanomas, Journal of Cranio-Maxillo-Facial Surgery (2013), http://dx.doi.org/10.1016/ j.jcms.2013.09.007