Elective Neck Dissection Does Not Improve Survival Rate but May Have Prognostic Role in Oral Cavity Mucosal Melanoma

by Linda Kossoff •

What are the outcomes and utility of elective neck dissections (ENDs) in the management of oral mucosal melanoma (MM), and how do demographic and clinical factors impact survival of oral cavity MM?

BOTTOM LINE

Age, race, male sex, lymph node involvement, and distant metastasis are associated with worse outcomes in patients with oral cavity MM; performing an END does not improve survival but it may have a prognostic role.

BACKGROUND: MMs comprise less than 1.3% of melanomas. Often found in the invasive, vertical growth phase, they are associated with worse outcomes. MMs make up less than 1% of oral cavity malignancies, but their incidence is increasing. Although ENDs are recommended for these cases, data on their benefits are lacking.

STUDY DESIGN: Retrospective analysis.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, N.J.

SYNOPSIS: Researchers mined the National Cancer Database (NCDB) for patients with oral cavity MM from 2004 to 2016. Demographic data in the analysis included patient age, sex, insurance status, household median income, facility type, and degree of urbanization. Of the 432 patients in the study (mean age 64 years), 60% were male and 85.0% were White. Findings suggested a five-year overall survival rate of 31.0%. The most common anatomical subsites were the gingiva and hard palate. Advanced age, N-stage, M-stage, male sex, and African American race were significantly associated with poorer survival. Most patients (83.8%) received surgery and 44.7% underwent radiotherapy as part of their treatment. A total of 199 patients underwent neck dissection. ENDs were not associated with improved outcomes, but pathological nodes were found in 28.3% of ENDs overall and in 45.4% with lymph node yield >18. This, said authors, indicates that a comprehensive neck dissection may be useful for staging and identifying candidates for treatment intensification, as well as for offering prognostic information to the patient. Study limitations included reliance on NCDB data integrity.

CITATION: Haimowitz S, Cohen DA, Dhanda A, et al. Mucosal melanoma of the oral cavity: What is the role of elective neck dissection? Laryngoscope. 2023;133:317–326.