Primary invasive melanoma on the head and neck: Distribution, ultraviolet exposure and histological subtype in 1,298 Australian patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8541-8541
Author(s):  
G. V. Long ◽  
B. K. Armstrong ◽  
M. H. Colman ◽  
H. M. Shaw ◽  
J. F. Thompson ◽  
...  
Keyword(s):  
Head And Neck ◽  
Histologic Type ◽  
Lentigo Maligna ◽  
Superficial Spreading ◽  
Ultraviolet Exposure ◽  
Desmoplastic Melanoma ◽  
Gender And Age ◽  
Histopathologic Diagnosis ◽  
Lentigo Maligna Melanoma ◽  
Obvious Association

8541 Background: The aim of this study was to determine the subsite distribution of invasive cutaneous melanoma of the head and neck and correlate this with the melanoma histologic type and ultraviolet exposure (UVE) at each particular subsite. Methods: This study comprised 1,298 patients seen at the Sydney Melanoma Unit (SMU) between 1990 and 2000. In each case, the histopathologic diagnosis of invasive melanoma was established by highly experienced SMU histopathologists. Histologic details, gender and patient age at diagnosis were available in all patients except in 5% in whom Breslow thickness could not be determined. Nine head and neck subsites were assigned: scalp, forehead, eyelids, nose, lips, chin, ears, face and neck. The relative tumour density (RTD) at each subsite was then examined in relation to gender and age of the patient and the relative UVE at this subsite. Relative UVE values as determined using polyusulphone UV dosimeters were used. Results: There was a direct correlation between high UVE and RTD at each subsite except the forehead (135 patients) and neck (335 patients), particularly in women, with the neck subsite prevailing in patients <50 years of age. Superficial spreading melanoma was the most common histologic type at all subsites except the lips (15 patients), nose (53 patients) and chin (15 patients), where desmoplastic melanoma predominated. Lentigo maligna melanoma was not more common on subsites having high UVE, nor was there an obvious association between melanoma thickness and UVE. Conclusions: The UVE was an important determinant of melanoma distribution on the head and neck. The lower RTDs at the forehead and neck subsites in women were possibly due to gender differences in hairstyles. Paradoxically, lentigo maligna melanoma, commonly considered to occur almost exclusively on sun-damaged skin, was not more common on areas of high UVE. No significant financial relationships to disclose.

scholarly journals Lentigo Maligna Melanoma of the Head and Neck

1993 ◽  
Vol 103 (5) ◽  
pp. 520???524 ◽  
Author(s):  
F. P. Johns Langford ◽  
Samuel R. Fisher ◽  
David W. Molter ◽  
Hilliard F. Seigler
Keyword(s):  
Head And Neck ◽  
Lentigo Maligna ◽  
Lentigo Maligna Melanoma

Considerations for Timing of Defect Reconstruction in Cutaneous Melanoma of the Head and Neck

2019 ◽  
Vol 35 (04) ◽  
pp. 404-409 ◽  
Author(s):  
Arya W. Namin ◽  
Georgeanne E. Cornell ◽  
Emily H. Smith ◽  
Robert P. Zitsch
Keyword(s):  
Head And Neck ◽  
Local Excision ◽  
Cutaneous Melanoma ◽  
Wide Local Excision ◽  
Tumor Thickness ◽  
Margin Status ◽  
Lentigo Maligna ◽  
Positive Margins ◽  
Lentigo Maligna Melanoma ◽  
Delayed Reconstruction

AbstractThe objective of this study is to identify the incidence and characteristics of cases with positive margins on wide local excision for cutaneous melanoma of the head and neck (CMHN) and therefore provide a potential basis for selectively delaying reconstruction pending final histological clearance of melanoma. A systematic review of English language articles was performed on studies retrieved from PubMed and Web of Science. Original investigations published between July 1999 and June 2018 reporting on margin status of CMHN wide local excision specimens were included in the review. The incidence of positive margins after definitive resection for cutaneous melanoma in the literature ranges from 6 to 20.9%. The incidence is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, tumor thickness, and ulceration. Delayed reconstruction remains the most oncologically sound decision, allowing for interpretation of margin status on paraffin-embedded tissue sections. However, resection and the resultant defect closure in a single stage is more expedient and potentially a more efficient use of resources. The risk–benefit ratio of immediate versus delayed reconstruction must be considered for each case. The incidence of positive margins is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, increasing tumor thickness, and the presence of ulceration; delayed reconstruction should be strongly considered in these cases.

Lentigo Maligna: Melanoma In Situ on Chronically Sun-Damaged Skin

2011 ◽  
Vol 135 (7) ◽  
pp. 838-841
Author(s):  
Jon A. Reed ◽  
Christopher R. Shea
Keyword(s):  
Review Of The Literature ◽  
Lentigo Maligna ◽  
Superficial Spreading ◽  
Anatomic Site ◽  
Classification Schemes ◽  
Melanoma In Situ ◽  
Personal Experiences ◽  
Lentigo Maligna Melanoma ◽  
Histologic Subtypes

Abstract Context.—Cutaneous primary invasive malignant melanoma often is classified by its histologic appearance. Major recognized histologic subtypes of melanoma include superficial spreading, lentigo maligna melanoma, nodular, and acral lentiginous. More recently, it has been shown that most primary invasive melanomas harbor nonrandom genetic or biochemical aberrations that correlate with anatomic site or with the amount of cutaneous exposure to sunlight. It also is generally accepted that most primary invasive melanomas are preceded by an intraepidermal atypical melanocytic proliferation that lacks invasive capability (melanoma in situ). Objective.—To focus on lentigo maligna, the preinvasive/in situ form of melanoma located on chronically sun-damaged skin. Data Sources.—Review of the literature and the authors' personal experiences. Conclusions.—A better understanding of the earliest stage of melanoma progression, including the contribution of chronic exposure to ultraviolet radiation, may lead to improved classification schemes that direct more effective targeted or personalized therapies for patients.

Positive Margins in Cutaneous Melanoma of the Head and Neck: Implications for Timing of Reconstruction

2020 ◽  
pp. 019459982096917
Author(s):  
Arya W. Namin ◽  
Lauren Welby ◽  
Austin T. Baker ◽  
Laura M. Dooley
Keyword(s):  
Surgical Treatment ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Spindle Cell ◽  
National Cancer Database ◽  
Clinicopathologic Features ◽  
Lentigo Maligna ◽  
Positive Margins ◽  
Lentigo Maligna Melanoma ◽  
The Face

Objective The aim of this study is to identify clinicopathologic features associated with positive margins after surgical treatment of cutaneous melanoma of the head and neck (CMHN). Study Design Retrospective cohort study. Setting National Cancer Database. Methods A retrospective analysis of the National Cancer Database was performed of patients diagnosed with CMHN between 2004 and 2016. Univariate and multivariate analyses examining the association of clinicopathologic features with positive margins were performed via logistic regression analysis. Results A total of 101,560 patients met inclusion criteria. The incidence of positive margins was 5.0% (5128/101,560). Patients were significantly more likely to have positive margins with the following: increasing age ( P < .001; odds ratio [OR], 1.028; 95% CI, 1.026-1.031), the lip subsite ( P < .001; OR, 1.664; 95% CI, 1.286-2.154), the eyelid subsite ( P < .001; OR, 2.380; 95% CI, 1.996-2.838), the face subsite ( P < .001; OR, 1.215; 95% CI, 1.133-1.302), the lentigo maligna/lentigo maligna melanoma subtype ( P = .019; OR, 1.099; 95% CI, 1.016-1.188), the desmoplastic subtype ( P < .001; OR, 1.455; 95% CI, 1.261-1.680), the spindle cell subtype ( P = .006; OR, 1.276; 95% CI, 1.073-1.516), and advanced pT classification. Patients with male sex ( P < .001; OR, 0.733; 95% CI, 0.687-0.782) and without ulceration ( P < .001; OR, 0.803; 95% CI, 0.736-0.876) were significantly less likely to have positive margins. Conclusion The following have been identified as clinicopathologic features associated with positive margins after surgical treatment of CMHN: increasing age, female sex, the lip subsite, the eyelid subsite, the face subsite, ulceration, the lentigo maligna/lentigo maligna melanoma subtype, the desmoplastic subtype, the spindle cell subtype, and increasing pT classification.

scholarly journals The radiotherapy of lentigo maligna and lentigo maligna melanoma of the head and neck

Cancer ◽  
1980 ◽  
Vol 45 (9) ◽  
pp. 2279-2283 ◽  
Author(s):  
Frank Dancuart ◽  
Andrew R. Harwood ◽  
Peter J. Fitzpatrick
Keyword(s):  
Head And Neck ◽  
Lentigo Maligna ◽  
Lentigo Maligna Melanoma

scholarly journals Anatomic Site, Sun Exposure, and Risk of Cutaneous Melanoma

2006 ◽  
Vol 24 (19) ◽  
pp. 3172-3177 ◽  
Author(s):  
David C. Whiteman ◽  
Mark Stickley ◽  
Peter Watt ◽  
Maria Celia Hughes ◽  
Marcia B. Davis ◽  
...  
Keyword(s):  
Occupational Exposure ◽  
Head And Neck ◽  
Cutaneous Melanoma ◽  
Sun Exposure ◽  
School Age ◽  
Lentigo Maligna ◽  
Superficial Spreading ◽  
Anatomic Site ◽  
Causal Pathways ◽  
Melanoma Patients

Purpose Sunlight is the principal environmental risk factor for cutaneous melanoma. A current hypothesis postulates that the role of sunlight in causing melanoma differs according to anatomic site. We tested this hypothesis in a population-based case-case comparative study of melanoma patients. Methods Patients were sampled from the Queensland cancer registry in three groups: superficial spreading or nodular melanomas of the trunk (n = 154), of the head and neck (HN; n = 76), and lentigo maligna (LM) and lentigo maligna melanoma (LMM; for both LM and LMM, n = 76). Data were collected on school-age sun exposure and occupational and recreational sun exposure in adulthood. Odds ratios (OR) and 95% CIs were calculated using polytomous logistic regression. Results HN melanoma patients were substantially more likely than trunk patients to have higher levels of sun exposure in adulthood (OR, 2.43; 95% CI, 0.98 to 5.99) and specifically, higher levels of occupational exposure (OR, 3.25; 95% CI, 1.32 to 8.00), but lower levels of recreational sun exposure (OR, 0.50; 95% CI, 0.21 to 1.19). LM and LMM patients reported higher occupational exposure and lower recreational sun exposure than trunk melanoma patients, although this was not significant. We found no significant differences between the groups for school-age sun exposures. Conclusion Melanomas developing at different body sites are associated with distinct patterns of sun exposure. Melanomas of the head and neck are associated with chronic patterns of sun exposure whereas trunk melanomas are associated with intermittent patterns of sun exposure, supporting the hypothesis that melanomas may arise through divergent causal pathways.

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