Prognostic factors in cutaneous melanoma of the head and neck.

Overview

The division of cutaneous malignant melanomas into nodular melanoma, malignant melanoma arising in Hutchinson's melanotic freckle and superficial spreading melanoma has, in many studies, indicated its usefulness for assessing prognosis. The depth of dermal invasion was also found to be an important prognostic factor. The present retrospective study of 119 patients, seen at Memorial Sloan-Kettering Cancer Center from 1947 to 1964, with cutaneous malignant melanoma of the head and neck area examines the above three types of melanoma as well as the depth of dermal invasion. The clinical and pathologic features and course of the disease in these patients were studied by means of a comprehensive statistical analysis. There was significant correlation between the depth of invasion and type of malignant melanoma, with the nodular type being the most deeply penetrating and melanoma arising in Hutchinson's melanotic freckle the most superficial (P < .01). The ten-year actuarial survival rates for clinical stage I patients when grouped according to dermal level of penetration were level II, 86%, vs level V, 44% (P < .01); levels III and IV were 60% and 57%, respectively. Correlations of importance were noted between ulceration and depth of dermal penetration, cellular pigment production and clinical pigmentation, as well as size of the primary lesion and depth of dermal invasion. It is suggested that future large-scale prospective studies include these useful parameters.