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Most lethal
Melanomas are on scalp and neck
Newswise — People with
scalp or neck melanomas die at nearly twice
the rate of people with melanoma elsewhere
on the body, including the face or ears,
researchers at the University of North
Carolina at Chapel Hill have found.
The analysis of 51,704
melanoma cases in the U.S. confirms that
survival rates differ depending on where
skin cancer first appears.
Those with scalp or
neck melanomas die at a rate 1.84 times
higher than those with melanomas on the
extremities, after controlling for the
possible influences of age, gender, tumor
thickness and ulceration.
“Scalp and neck melanomas patients have a
higher rate of death than patients with
melanoma anywhere else on the body,” said
Nancy Thomas, M.D., Ph.D., associate
professor of dermatology in the UNC School
of Medicine, a member of the UNC Lineberger
Comprehensive Cancer Center and the study’s
senior author.
Anne Lachiewicz, a
medical student in the UNC School of
Medicine, is the lead author of the study.
Thomas recommends that
physicians pay special attention to the
scalp when examining patients for signs of
skin cancer.
“Only six percent of
melanoma patients present with the disease
on the scalp or neck, but those patients
account for 10 percent of melanoma deaths.
That’s why we need to take extra time to
look at the scalp during full-skin
examinations,” she said.
The results appear in
the April issue of the journal Archives
of Dermatology.
The study helps address
a controversy among cancer researchers:
whether scalp and neck skin cancer is more
lethal primarily because it’s diagnosed
later than other melanomas.
“That was the thinking
of a lot of people in the field,” Thomas
said. But the analysis indicates that the
presence of the melanoma on the scalp or
neck, in itself, is an indicator of a poorer
prognosis.
“We think there’s
something different about scalp and neck
melanomas,” Thomas said.
“This gives us
directions for research to look at tumor
cell types in those areas at the molecular
level and to see if there are differences.
I’m interested in identifying the mutations
that drive malignancy.”
Thomas, Lachiewicz and
their colleagues analyzed data from 13
National Cancer Institute Surveillance
Epidemiology and End Results (SEER) Program
registries in nine states. Each case
represented the first invasive melanoma
diagnosed among non-Hispanic white adults
between 1992 and 2003.
Patients with scalp or
neck melanomas were older (59 years) than
patients with other melanomas (55 years),
and more likely to be male (74 percent
versus 54 percent, respectively). In
addition, scalp and neck melanomas were
thicker (0.8 millimeters) than melanomas at
other sites (0.6 millimeters) and more
likely to be ulcerated. Lymph node
involvement was also more common in patients
with scalp-neck melanomas.
Melanomas on the
extremities or on the face or ears had the
best prognosis.
The five-year
melanoma-specific survival rate for patients
with scalp or neck melanomas was 83 percent,
compared with 92 percent for patients with
melanomas at other sites. The ten-year
survival rate was 76 percent for scalp or
neck melanomas and 89 percent for other
melanomas.
Study co-authors are
Drs. Marianne Berwick and Charles Wiggins of
the University of New Mexico.
Funding was provided by
the National Cancer Institute and a
Holderness Medical Foundation Fellowship to
Lachiewicz.
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