According to this study:

* Patients with melanomas of the scalp or neck have lower survival rates than patients with melanomas at other sites.

* Health care providers should pay particular attention to the scalp and neck during routine skin exams.

To compare the survival of patients with melanomas of the scalp or neck with that of patients with melanomas at other locations, the authors of this study used data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. The SEER data, collected nationwide from 1992 to 2003, included non-Hispanic white patients 20 years old or older with initial, invasive, cutaneous, microscopically confirmed melanomas.

Data from 51,704 patients were included. The melanomas varied in location: 43% were on the extremities, 34% were on the trunk, 12% were on the face or ears, 6% were on the scalp or neck, and 4% were at an unspecified location. Compared with patients with melanomas at other locations, those with melanomas on the scalp or neck were significantly more likely to be male and to have thicker tumors, to be older at diagnosis, and to have ulcerated melanomas, positive lymph nodes, and nodular or lentigo maligna melanomas.

Of patients with scalp or neck melanomas, 14% died. In comparison, 6% with melanomas on the extremities died, 8% with trunk melanomas died, and 6% of patients with face or ear melanomas died; the largest percentage of deaths (44%) occurred in patients with melanomas at unknown sites. Patients with scalp or neck melanomas were nearly twice as likely to die from their melanoma as were patients with melanomas of the extremities. Patients with scalp or neck melanomas had lower five-and 10-year survival probabilities (83.1% and 76.2%, respectively) than patients with melanomas at other locations (92.1% and 88.7%, respectively).

These data show that patients with scalp or neck melanomas have worse survival rates than those with melanomas at other locations (for example, only 6% of patients had scalp or neck melanomas, but these patients made up 10% of all deaths from melanoma); however, the reason for this relationship is unclear.

The authors recommend that health care providers take special care in examining the scalp and neck when screening for melanomas and conducting full-body skin examinations. Also, providers should discuss with patients the importance of wearing head and neck protection when outdoors.

SDSJ