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Updated: Dec 30, 2025
A 3D Organotypic Melanoma Spheroid Skin Model
Published on: May 18, 2018
Patterns of failure in patients with cutaneous head and neck melanoma
Gideon Bachar1, Sharon Tzelnick1, Nimrod Amiti2
1Department of Otolaryngology, Head and Neck Surgery, Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Introduction:
The incidence of head and neck melanoma is increasing. Various factors influence prognosis.
Objective:
We sought to investigate the subgroup of patients with head and neck melanoma who fail primary treatment and to define the patterns of failure.
Methods:
The database of a tertiary medical center was reviewed for patients diagnosed and surgically treated for cutaneous head and neck melanoma in 1995-2014. Regional disease failure was defined as disease confirmed in positive SLNB at first assessment or at recurrence.
Results:
The cohort included 141 patients followed for a median duration of 6.8 years (range 1-20 years). Median tumor thickness was 2.1 mm (range 0.5-12 mm). Ulceration was documented in 38 patients (26.9%). Sentinel lymph node biopsy (SLNB) was positive in 18 patients (12.8%). Total disease failure rate was 32.6% with similar rates of regional (n = 26, 18.4%) and distal (n = 22, 15.6%) failure. Most patients (86.3%) with systemic recurrence had a negative SNLB as did 6/26 patients (23%) with regional failure. Forty-three patients (30.4%) died during follow-up, half of them (23 patients, 16.3%) of melanoma. On multivariate analysis, Breslow thickness was the only significant predictor of outcome.
Conclusions:
The pattern of treatment failure in patients with head and neck melanoma relate predominantly to Breslow thickness. The high false-negative rate of SNLB and the relatively high rate of systemic failures in patients with negative SNLB indicate a low predictive value of this procedure. Efforts to detect systemic disease during follow-up need to be intensified.
Insights
Head and neck melanoma treatment failure is linked to tumor thickness. Sentinel lymph node biopsy (SLNB) has limited predictive value, and systemic recurrence is common even with negative SLNB results.
Area of Science:
- Oncology
- Dermatology
- Surgical Pathology
Background:
- The incidence of head and neck melanoma is rising globally.
- Prognosis in head and neck melanoma is influenced by multiple factors.
Purpose of the Study:
- To investigate treatment failure patterns in head and neck melanoma patients.
- To define the characteristics of disease recurrence after primary treatment.
Main Methods:
- Retrospective review of 141 patients with head and neck melanoma treated between 1995-2014.
- Analysis of regional and distal disease failure, including sentinel lymph node biopsy (SLNB) status.
- Multivariate analysis to identify predictors of outcome.
Main Results:
- Median follow-up was 6.8 years; median tumor thickness was 2.1 mm.
- Overall disease failure rate was 32.6%, with similar regional and distal failure rates.
- Breslow thickness was the sole significant predictor of outcome on multivariate analysis.
Conclusions:
- Treatment failure in head and neck melanoma is primarily associated with Breslow thickness.
- Sentinel lymph node biopsy (SLNB) demonstrated a high false-negative rate and limited predictive value.
- Intensified efforts for systemic disease detection during follow-up are recommended.
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