Anatomic Region of Cutaneous Melanoma Impacts Survival and Clinical Outcomes: A Population-Based Analysis

SIMPLE SUMMARY: Despite the increasing incidence of melanoma in the United States, few studies have compared tumor and clinical characteristics of cutaneous melanoma by anatomic region with an analysis of survival outcomes. The goal of the current study was to determine how the anatomic region of a cutaneous melanoma affects an individual’s overall survival rate. In this cross-sectional study that included 178,892 cases, cutaneous melanoma of the head and neck region was associated with the greatest risk of death (HR 1.90 [95% CI, 1.85–1.96]) compared to other sites, a finding that suggests that anatomic site should be considered for inclusion in future editions of staging criteria to improve the overall management of patients diagnosed with cutaneous melanoma. ABSTRACT: Purpose: The objective was to determine the effects of the anatomic site of a cutaneous melanoma on the survival outcomes of diagnosed individuals. Methods: We conducted a cross-sectional study using data from the Surveillance, Epidemiology, and End Results Program (SEER) Database from 2004–2014 and included 178,892 cases of individuals diagnosed with cutaneous melanoma. Overall survival (OS) for each anatomic site as well as associated demographics, primary site, stage, and pathologic prognostic factors (Breslow’s depth of invasion (DOI), level of mitoses, and ulceration), were analyzed. Results: Lower extremity melanoma (LEM) was the most likely to have locoregional nodal spread, yet head and neck melanoma (HNM) was the most likely to present at the most advanced stage of disease (IV). Independent of other factors, HNM was associated with the greatest risk of death (HR 1.90 [95% CI, 1.85–1.96]) compared to other sites, and males experienced worse overall survival (OS) (HR 1.74 [95% CI, 1.70–1.78]) compared to females. The last and greatest risk of death is associated with LEM and HNM, respectively. Conclusion: Given these survival differences, consideration should be given to incorporating the primary site of melanoma into staging to ensure treatment is efficacious as possible.