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A Population-Based Study

Alexander Golger, MD; Diana S. Young, BSc; Danny Ghazarian, PhD; Peter C. Neligan, MB

Arch Otolaryngol Head Neck Surg. 2007;133(5):442-447.

Objectives  To describe the epidemiological features of cutaneous head and neck melanoma (CHNM) and to identify factors associated with mortality from this disease.

Design  A population-based cohort study.

Setting  Patients treated for CHNM in Ontario between January 1, 1994, and December 31, 2002, were identified through the provincial Cancer Registry. A Cox proportional hazards regression model was used to analyze the data.

Patients  A total of 2218 patients with CHNM were identified, comprising 15.8% of all melanomas in Ontario. The mean age of the cohort was 66 years (SD, 16 years); 1363 patients (61.5%) were males.

Main Outcome Measure  Patients' vital status (dead or alive).

Results  The incidence of CHNM increased from 2.0 per 100 000 in 1996 to 2.7 per 100 000 in 2001, while mortality remained stable. The Cox proportional hazards regression model showed that increased age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.04-1.06) and male sex (HR, 1.31; 95% CI, 1.03-1.66) had a significantly higher risk of death. Patients with lesions of the scalp and neck had a 53% higher risk of death than those with lesions of the face. Nodular melanoma (HR, 1.61; 95% CI, 1.17-2.24) had the worst prognosis compared with other morphological types. Increased tumor thickness (HR, 1.05; 95% CI, 1.03-1.07), ulceration (HR, 1.53; 95% CI, 1.08-2.07), and Clark level V (HR, 1.52; 95% CI, 1.01-2.22) were significantly associated with increased mortality.

Conclusions  Our study demonstrated an increase in the incidence of CHNM. Advanced age, male sex, nodular morphological features, tumor thickness, ulceration, and Clark level V carried a significant risk of death, whereas facial melanomas had a favorable prognosis.

Author Affiliations: Division of Plastic Surgery, Department of Surgery, University of Toronto (Drs Golger and Neligan and Ms Young), and Department of Pathology, Princess Margaret Hospital, University Health Network (Dr Ghazarian), Toronto, Ontario.

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