TY - JOUR
T1 - A cohort analysis of surgically treated primary head and neck lentigo maligna (melanoma)
T2 - Prognostic value of melanoma subtype and new insights in the clinical value of guideline adherence
AU - Elshot, Yannick S.
AU - Zupan-Kajcovski, Biljana
AU - Ouwerkerk, Wouter
AU - Klop, W. Martin C.
AU - Lohuis, Peter J. F. M.
AU - Bol, Mijke
AU - Crijns, Marianne B.
AU - Bekkenk, Marcel.W.
AU - de Rie, Menno A.
AU - Balm, Alfons J. M.
N1 - Funding Information: None. Publisher Copyright: © 2022
PY - 2023/4
Y1 - 2023/4
N2 - Background: Knowledge about lentigo maligna (melanoma) (LM/LMM) and its associated prognostic clinicopathological characteristics are limited compared to that of non-LM/LMM subtypes. The current study aimed to determine the clinical relevance of the LM/LMM subtype and its influence on recurrence and survival outcomes. Methods: All consecutive cases of primary cutaneous head and neck LM/LMM treated by wide local excision over a ten-year period were retrospectively reviewed and compared to non-LM/LMM. Clinical outcome and prognostic factors were assessed by cumulative incidence and competing risk analyses. Results: A total of 345 patients were identified. Specific clinicopathological characteristics such as lower median Breslow thickness (1.6 mm versus 2.1 mm; P = 0.013), association with diagnostic sampling errors (17.3% versus 5.2%; P = 0.01), and increased risk of local recurrences due to incomplete resection (18.7% versus 2.3%; P < 0.001), were significantly associated with LM/LMM. Guideline adherence was similar between the two study groups. The positive nodal status at baseline for LMM was low compared to non-LM/LMM (4.2% vs 17.9%; P = 0.037). The LMM subtype, facial localization, and reduced surgical margins (i.e., guideline non-adherence) were not shown to be independent prognostic factors for disease-free, melanoma-specific, or overall survival after correction for competing risks such as patient age and Breslow thickness. Conclusions: The LMM subtype was not shown to be prognostically different from non-LM/LMM when corrected for other variables of influence such as patient age and Breslow thickness. Reduced resection margins did not seem to affect disease-free, and melanoma-specific survival and warrant LM/LMM-specific guidelines. Further research is needed to evaluate the value of SLNB in LMM patients.
AB - Background: Knowledge about lentigo maligna (melanoma) (LM/LMM) and its associated prognostic clinicopathological characteristics are limited compared to that of non-LM/LMM subtypes. The current study aimed to determine the clinical relevance of the LM/LMM subtype and its influence on recurrence and survival outcomes. Methods: All consecutive cases of primary cutaneous head and neck LM/LMM treated by wide local excision over a ten-year period were retrospectively reviewed and compared to non-LM/LMM. Clinical outcome and prognostic factors were assessed by cumulative incidence and competing risk analyses. Results: A total of 345 patients were identified. Specific clinicopathological characteristics such as lower median Breslow thickness (1.6 mm versus 2.1 mm; P = 0.013), association with diagnostic sampling errors (17.3% versus 5.2%; P = 0.01), and increased risk of local recurrences due to incomplete resection (18.7% versus 2.3%; P < 0.001), were significantly associated with LM/LMM. Guideline adherence was similar between the two study groups. The positive nodal status at baseline for LMM was low compared to non-LM/LMM (4.2% vs 17.9%; P = 0.037). The LMM subtype, facial localization, and reduced surgical margins (i.e., guideline non-adherence) were not shown to be independent prognostic factors for disease-free, melanoma-specific, or overall survival after correction for competing risks such as patient age and Breslow thickness. Conclusions: The LMM subtype was not shown to be prognostically different from non-LM/LMM when corrected for other variables of influence such as patient age and Breslow thickness. Reduced resection margins did not seem to affect disease-free, and melanoma-specific survival and warrant LM/LMM-specific guidelines. Further research is needed to evaluate the value of SLNB in LMM patients.
KW - Head and neck
KW - Lentigo maligna melanoma
KW - Margins
KW - Prognosis
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85139199506&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2022.08.012
DO - https://doi.org/10.1016/j.ejso.2022.08.012
M3 - Article
C2 - 36031471
SN - 0748-7983
VL - 49
SP - 818
EP - 824
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 4
ER -