Predictors of survival in head and neck mucosal melanoma. (October 2017) - Schmidt, Matthew Q.
Highlights: This is the largest study of head and neck mucosal melanomas to date. Prognosis remains poor with a 27.9% 5-year overall survival. Paranasal sinus tumors have worse prognosis than other head and neck sites. Surgery with or without radiation has better survival than non-surgical approaches. There has been increased use of multi-modality treatment over the last decade. Abstract: Objectives: To evaluate hospital-based data of head and neck mucosal melanoma patients in order to identify predictors of survival. Materials and methods: The National Cancer Data Base was used to identify 1368 patients with head and neck mucosal melanoma diagnosed between the years of 2004 and 2012. The Kaplan-Meier method was utilized to estimate overall survival, and multivariate Cox regression analyses were performed to assess the impact of covariates on survival after adjusting for confounding variables. Results: Median follow-up was 55.2 months. Median survival of all patients was 29.3 months, and the 5-year survival was 27.4%. After adjusting for other prognostic factors in multivariate analysis, paranasal sinus location [hazard ratio (HR) = 1.54, 95% Confidence Interval (CI) = 1.30–1.82, P < 0.001)] and the use of radiotherapy alone for definitive local treatment (HR = 2.27, 95% CI = 1.72–2.98, P < 0.001) were associated with worse survival. Similar results were seen in the subgroup of patients with complete clinical staging information. In terms of patterns of care, the use of combined surgery and radiotherapy as the primary local treatment modality has significant increased from 2004 and 2012 (P = 0.03). Conclusion: Outcomes in mucosal melanoma of the head and neck remain suboptimal, despite increased use of multimodality local therapy, likely due to the high risk of distant metastases. Mucosal melanomas arising from the paranasal sinuses have particularly poor prognosis. Novel therapeutic paradigms for head and neck mucosal melanoma, incorporating systemic therapies to decrease the risk of distant relapse, should be pursued in clinical trials.