Regression Not a Negative Prognostic Indicator of Primary Cutaneous Head–Neck Melanoma

What is the impact of regression on sentinel node status and the likelihood of recurrence in primary cutaneous melanoma of the head and neck?

BOTTOM LINE: Regression may not be a negative prognostic indicator in patients with cutaneous melanoma of the head and neck.

BACKGROUND: Understanding melanoma’s complex biology requires continual analysis and refinement of the disease’s prognostic factors. Microscopic features such as tumor thickness and ulcerations are considered dominant prognostic factors for melanoma. However, the prognostic significance of other microscopic features of the disease, such as mitotic rate and regression, are less clear.

STUDY DESIGN: Retrospective analysis.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis.

SYNOPSIS: Researchers conducted a retrospective analysis of 191 adults who underwent surgical management for primary cutaneous melanoma of the head and neck between May 2002 and March 2019. Histologic features were assessed for melanoma subtype, Breslow thickness, Clark level, presence/absence of ulceration, mitotic rate per square millimeter, and regression. Twenty-five patients were found to have presence of regression. Of these, 17 had a sentinel lymph node biopsy (SLNB) and three were found to have a positive sentinel node. Patients with regression had thinner melanomas. Ninety-eight patients without regression had an SLNB, and 26 of these were found to have a positive sentinel node. Three patients with regression experienced recurrence, while 50 patients without regression had a recurrence. Mitotic rate >2 trended toward a higher rate of positive sentinel node status and was significantly associated with recurrence. Researchers’ findings demonstrated no clear evidence of regression as a negative prognostic indicator of primary cutaneous melanoma of the head and neck. Study limitations included a small sample size and incomplete patient data sets.

CITATION: Kim E, Obermeyer I, Rubin N, Khiariwala SS. Prognostic significance of regression and mitotic rate in head and neck cutaneous melanoma [published online ahead of print December 16, 2020]. Laryngoscope Investig Otolaryngol. doi:10.1002/lio2.509.